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Donlon NE, Ravi N, King S, Cunninhgam M, Cuffe S, Lowery M, Wall C, Hughes N, Muldoon C, Ryan C, Moore J, O'Farrell C, Gorry C, Duff AM, Enright C, Nugent TS, Elliot JA, Donohoe CL, Reynolds JV. Modern oncological and operative outcomes in oesophageal cancer: the St. James's hospital experience. Ir J Med Sci 2020; 190:297-305. [PMID: 32696244 DOI: 10.1007/s11845-020-02321-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/17/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Oesophageal cancer has a reputation for poor survival, and a relatively high risk of major postoperative morbidity and mortality. Encouragingly, a recent international cancer registry study reports a doubling of survival outcomes in Ireland over the last 20 years. This study focused on both oncologic and operative outcomes in patients treated with curative intent requiring surgery at a high-volume center. METHODS All patients undergoing surgery or multimodal therapy with curative intent from 2009 to 2018 were studied. All data was recorded prospectively and maintained internally. The period 2009-2013 was compared with 2014-2018 to monitor any change in trends. RESULTS Four hundred and seventy-five patients (adenocarcinoma 77%, mean age 65; 76% male; 64% neoadjuvant therapy) underwent open surgical resection, 54% via en bloc 2-stage, 19.8% en bloc 3-stage, and 26.5% by a transhiatal approach. New onset atrial fibrillation was the commonest index complication, in 108 (22.7%), 80 (18%) developed suspected pneumonia/respiratory tract infection, 20 (4.2%) an anastomotic leak, and 25 (5.2%) a chyle leak. The 90-day mortality rate was 1.2% and 0.8% at 30 days. The median survival was 77.17 months, with a 5-year survival of 56%. CONCLUSION Consistent with registry data on population survival for oesophageal cancer, this study highlights markedly improved survival outcomes in patients treated curatively, reflecting international trends, as well as low mortality rates; however, cardiorespiratory complications remain significant.
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Affiliation(s)
- Noel E Donlon
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland.
| | - Narayanasamy Ravi
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Sinead King
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Moya Cunninhgam
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Sinead Cuffe
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Maeve Lowery
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Carmel Wall
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Niall Hughes
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Cian Muldoon
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Ciara Ryan
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Jenny Moore
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Catherine O'Farrell
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Claire Gorry
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Ann-Marie Duff
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Cathy Enright
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Tim S Nugent
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Jessie A Elliot
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Claire L Donohoe
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - John V Reynolds
- National Oesophageal and Gastric Centre, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland
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Brusselaers N, Mattsson F, Lagergren J. Hospital and surgeon volume in relation to long-term survival after oesophagectomy: systematic review and meta-analysis. Gut 2014; 63:1393-400. [PMID: 24270368 DOI: 10.1136/gutjnl-2013-306074] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Centralisation of healthcare, especially for advanced cancer surgery, has been a matter of debate. Clear short-term mortality benefits have been described for oesophageal cancer surgery conducted at high-volume hospitals and by high-volume surgeons. OBJECTIVE To clarify the association between hospital volume, surgeon volume and hospital type in relation to long-term survival after oesophagectomy for cancer, by a meta-analysis. DESIGN The systematic literature search included PubMed, Web of Science, Cochrane library, EMBASE and Science Citation Index, for the period 1990-2013. Eligible articles were those which reported survival (time to death) as HRs after oesophagectomy for cancer by hospital volume, surgeon volume or hospital type. Fully adjusted HRs for the longest follow-up were the main outcomes. Results were pooled by a meta-analysis, and reported as HRs and 95% CIs. RESULTS Sixteen studies from seven countries met the inclusion criteria. These studies reported hospital volume (N=13), surgeon volume (N=4) or hospital type (N=4). A survival benefit was found for high-volume hospitals (HR=0.82, 95% CI 0.75 to 0.90), and possibly also, for high-volume surgeons (HR=0.87, 95% CI 0.74 to 1.02) compared with their low-volume counterparts. No association with survival remained for hospital volume after adjustment for surgeon volume (HR=1.01, 95% CI 0.97 to 1.06; N=2), while a survival benefit was found in favour of high-volume surgeons after adjustment for hospital volume (HR=0.91, 95% CI 0.85 to 0.98; N=2). CONCLUSIONS This meta-analysis demonstrated better long-term survival (even after excluding early deaths) after oesophagectomy with high-volume surgery, and surgeon volume might be more important than hospital volume. These findings support centralisation with fewer surgeons working at large centres.
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Affiliation(s)
- Nele Brusselaers
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Mattsson
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Division of Cancer Studies, King's College London, General Surgery Offices, St Thomas' Hospital, London, UK
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