Comparison of short-term outcomes from the International Oesophago-Gastric Anastomosis Audit (OGAA), the Esophagectomy Complications Consensus Group (ECCG), and the Dutch Upper Gastrointestinal Cancer Audit (DUCA)
James FergussonEdwin BeenenCharles A. MosseJoshua SalimS CheahTimothy WrightM P CerdeiraPatrick McQuillanMark P. RichardsonHan LiemJohn SpillaneMyla YacobF. AlbadawiT. ThorpeAnn F. DingleCarlos S. CabalagKen LoiOM FisherS WardMatthew ReadMary Ann JohnsonR. BassariHai T. BuiIvan CecconelloRAA SallumJRM da RochaLucia Rossetti LopesValdir TerciotiJDS CoelhoJAP FerrerGordon BuduhanLijie TanSadeesh SrinathanP SheaJonathan YeungFrances AllisonPaul CarrollFelipe Vargas-BaratoFelipe GonzálezJoaquín OrtegaLaura Niño TorresT.C. Beltrán-GarcíaL. CastillaMiguel A. PinedaA. BastidasJorge L. Gomez-MayorgaNatalia CortésC. CetaresS CaceresSebastião Júnior Henrique DuarteA PazdroMartin SnajdaufH. FaltovaM. SevcikovaPreben Bo MortensenNiels KatballeT. IngemannBrianna C. MortenI. KruhlikavaAP AinswortNM StillingJens EckardtJens‐Christian HolmMorten ThorsteinssonMette SiemsenB BrandtBerhanu NegaE. TeferraAyalew TizazuJoonas H. KauppilaVesa KoivukangasSanna MeriläinenRobert GruetzmannChristian KrautzGeorg F. WeberHenriette GolcherGeorg EmonsAzadeh AzizianMara C. EbelingStefan NiebischNicole KreuserG. AlbaneseJ. HesseL. VolovnikU. BoecherMatthias ReehS. TriantafyllouDimitriοs SchizasAdamantios MichalinosE. MpaliMaria MpouraAlexandros CharalabopoulosDimitrios K. ManatakisDimitrios BalalisJarlath BolgerChwanrow BabanAchille MastrosimoneO. J. McAnenaAoife QuinnCB Ó SúilleabháinMM HennessyIvan IvanovskiH. KhizerNarayanasamy RaviNoel E. DonlonMaurizio CervelleraSamuele VaccariS. BianchiniLodovico SartarelliEmanuele AstiDaniele BernardiStefano MeriglianoLuigi ProvenzanoMarco ScarpaLuca SaadehBeatrice SalmasoGiovanni De ManzoniSimone GiacopuzziRoberta La MendolaCA De PasqualYasuhiro TsubosaMasahiro NiiharaTomoyuki IrinoRie MakuuchiKenjiro IshiiMichael MwachiroArega FekaduAgneta OderaElizabeth MwachiroDerar Al-ShehabHA AhmedAO ShebaniMuhammed ElhadiF.A. ElnagarHF ElnagarST Makkai-PopaL F WongT YunrongS ThanninalaiH C AikPW SoonTJ HueiHNL BasaveRubén Cortés‐GonzálezSM LagardeJJB van LanschotCharlotte I. CordsW.A. JansenIngrid S. MartijnseR MatthijsenStefan A.W. BouwenseBastiaan KlarenbeekMoniek VerstegenFrans van WorkumJP RuurdaPC van der SluisM de MaatN. EvenettPeter F. JohnstonRajan PatelAndrew MacCormickMichael K. YoungBaxter SmithC EkwunifeAH MemonK ShaikhAbdul WajidNasir KhalilM HarisZU MirzaSBA QudusMZ SarwarA. ShehzadiA RazaM.H. JhanzaibJ. FarmanaliZ. ZakirOsama ShakeelI NasirShahid KhattakM. K. BaigMA NoorHanaa H. AhmedAtif NaeemAC PinhoR da SilvaH MatosT BragaCecília MonteiroPaulo RamosFrancisco CabralMP GomesPC MartinsAM CorreiaJF VideiraC CiuceRadu DrasoveanRaluca Cristina ApostuC CiuceŞtefan PaiticiA.E. RacuCV ObleagaMircea BeuranBogdan StoicaCezar CiubotaruValentina Madalina NegoitaIoan CordoşRodica BîrlăDragoş PredescuPA HoaraR TomsaV. ShneiderMalik AgasievI. GanjaraDragan GunjićMilan VeselinovićTamara BabičTS ChinAsim ShabbirG KimA CrnjacH. SamoIsmael Díez del ValS LeturioIsmael Díez del ValS LeturioJM RamónMariagiulia Dal CeroS. RifáM RicoAlberto Pagán PomarJA Martinez CorcolesJosé L. RodicioSA PaisSA TurienzoL.S. AlvarezPV CamposA.G. RendoSS GarcíaE.P.G. SantosE. Torres MartínezMJ Fernández DíazCristina Magadán ÁlvarezV Concepción MartínClémentine LopezA Rosat RodrigoLuis Eduardo Pérez SánchezM. Bailón-CuadradoClaudia Tinoco CarrascoE Choolani BhojwaniDP SánchezME AhmedT. DzhendovFredrik LindbergMartin RutegårdMagnus SundbomC MickaelNicola ColucciArmin SchniderSadettin ErEray KurnazSerdar TürkyılmazAtilla TürkyılmazReyyan YıldırımBE BakiNezih AkkapuluÖmer KarahanNurullah DamburacıRichard HardwickPeter SafranekVijay SujendranJohn M. BennettZeeshan AfzalM ShrotriB ChanKlaire ExarchouTimothy GilbertT AmaleshDipankar MukherjeeSomnath MukherjeeTH WigginsRaymond KennedyStephen McCainAndrew B. HarrisGary DobsonNatalie J. DaviesIan WilsonDamian MayoDavinia BennettRichard L. YoungP. ManbyNatalie BlencoweM. SchillerBen ByrneDavid MittonVincent Wai‐Sun WongAmany ElshaerMike CowenVijay G. MenonLC TanEdward F. McLaughlinRenol KoshyC SharpH BrewerN DasM. CoxW. Al KhyattDawit WorkuRamiz IqbalL WallsR McGregorGrant FullartonA MacdonaldC. K. MackayC CraigSimon DwerryhouseSteve HornbyShameen JaunooMartin WadleyCara BakerM SaadMichael E. KellyAndrew DaviesFrancesco Di MaggioS McKayP MistryR SinghalOlga TuckerSpyridon KapoulasSarah Powell‐BrettPhilip J. DavisG. BromleyL. WatsonR. VermaJeremy WardVinutha ShettyChad G. BallKish PursnaniAbeezar SarelaLing HaoS. MehtaJeremy D. HaydenN. ToTom PalserDavid HunterK SupramaniamZ ButtAli AhmedS. Saravana KumarA ChaudryOsama MoussaAli KordzadehBruno LorenziJ WillemGeorge BourasRichard EvansManoj K. SinghH. WarrilowA AhmadN TewariFady YanniJennifer CouchElena TheophilidouJ.J. ReillyPritam SinghGijs van BoxelKhalid AkbariDaniela ZanottiBruno SgromoGrant SandersTim WheatleyArun AriyarathenamAlexander M. Reece-SmithLee HumphreysC ChohN CarterB KnightPH PucherAntonios AthanasiouI. MohamedBin TanM AbdulrahmanJ VickersKhurshid AkhtarRam ChaparalaR. BrownMMA AlasmarRoger AckroydKrashna PatelAnup Sunil TamhankarA WymanRobert A. WalkerLeena Grace BeslinN AbbassiN. SlimL IoannidiGuy BlackshawTimothy HavardXavier EscofetArfon PowellAnas OweraFarhan RashidPeriyathambi JambulingamJ. PadickakudiHakim BenyounesKirsty McCormackIA MakeyM.K. KarushCW SederMJ LiptayG. ChmielewskiE G RosatoA.C. BergerRichard ZhengEmanuel OkoloAnima SinghCD ScottMJ WeyantJ D Mitchell
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Abstract:
The Esophagectomy Complications Consensus Group (ECCG) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA) have set standards in reporting outcomes after oesophagectomy. Reporting outcomes from selected high-volume centres or centralized national cancer programmes may not, however, be reflective of the true global prevalence of complications. This study aimed to compare complication rates after oesophagectomy from these existing sources with those of an unselected international cohort from the Oesophago-Gastric Anastomosis Audit (OGAA).The OGAA was a prospective multicentre cohort study coordinated by the West Midlands Research Collaborative, and included patients undergoing oesophagectomy for oesophageal cancer between April and December 2018, with 90 days of follow-up.The OGAA study included 2247 oesophagectomies across 137 hospitals in 41 countries. Comparisons with the ECCG and DUCA found differences in baseline demographics between the three cohorts, including age, ASA grade, and rates of chronic pulmonary disease. The OGAA had the lowest rates of neoadjuvant treatment (OGAA 75.1 per cent, ECCG 78.9 per cent, DUCA 93.5 per cent; P < 0.001). DUCA exhibited the highest rates of minimally invasive surgery (OGAA 57.2 per cent, ECCG 47.9 per cent, DUCA 85.8 per cent; P < 0.001). Overall complication rates were similar in the three cohorts (OGAA 63.6 per cent, ECCG 59.0 per cent, DUCA 62.2 per cent), with no statistically significant difference in Clavien-Dindo grades (P = 0.752). However, a significant difference in 30-day mortality was observed, with DUCA reporting the lowest rate (OGAA 3.2 per cent, ECCG 2.4 per cent, DUCA 1.7 per cent; P = 0.013).Despite differences in rates of co-morbidities, oncological treatment strategies, and access to minimal-access surgery, overall complication rates were similar in the three cohorts.Keywords:
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To compare the complications associated with mechanical and manual cervical esophagogastric anastomosis following esophagectomy for esophageal cancer.From September, 2004 to June, 2007, 227 patients with middle and upper thoracic esophageal cancer underwent cervical esophagogastric anastomosis after esophagectomy. The patients were randomized into two groups and cervical esophagogastric anastomosis was performed using a stapler (n=102) or manually (n=125). The incidence of postoperative complications and operative time were compared between the two groups.In manual anastomosis group, anastomotic leak and anastomotic stricture occurred in 14.4% (18/125) and 8.8.% (11/125) of the patients, significantly higher than the incidences of 2.9% (3/102) and 3.9% (4/102) in the mechanical anastomosis group (P<0.01). Manual anastomosis required a significantly longer operative time than mechanical anastomosis (52∓12 vs 25∓5 min, P<0.01).The use of circular mechanical stapler in cervical esophagogastric anastomosis is associated with a lower rate of anastomotic leak and a shorter operative time, and is easy to learn and standardize to reduce the complications of the anastomosis.
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Esophageal reconstruction is of great importance in the practice of esophagectomy, and esophago-gastric anastomosis represents the most essential and key technical aspect of the operation, which largely determined patients′ short-term outcomes. A successful esophageal anastomosis should be no occurrences of postoperative early-stage anastomotic bleeding and leakage and later-stage anastomotic stenosis. The circular stapler, linear cut stapler and hand-sewn anastomosis are the most common anastomotic methods. Hand-sewn anastomosis is the most traditional and classical. Circular stapler has gained significant popularity for its simplicity and convenience. Linear cut stapler used for side-to-side anastomosis has the potential to reduce the risk of postoperative anastomotic stenosis via expanding inner diameter of anastomosis. Every anastomotic method has its advantages and disadvantages, and it cannot completely avoid occurrence of postoperative anastomotic complications. To have a better outcome, both surgeon′s experiences and patient′s individual conditions should be taken into consideration for the choice of anastomotic technique.
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Definitive chemoradiotherapy has been demonstrated to offer a chance of cure for esophageal cancer as often as a radical esophagectomy. However, it is generally accepted that an esophagectomy remains the mainstay of treatment for patients with resectable esophageal cancer, while chemoradiotherapy is the standard for patients with medically inoperable or surgically unresectable esophageal cancer. The mortality rates and the 5-year survival rates after an esophagectomy were 29% and 4%, respectively, in an early extensive reviews involving 122 English papers on esophageal cancer surgery published between 1960 and 1979. The respective rates have improved to 6.7% and 27.9% in the most recent systematic reviews involving 312 papers published between 1990 and 2000. The overall survival at 5 years was 36.1% after esophagectomy in 11,642 patients between 1988 and 1997 in Japan. A 3-field lymphadenectomy involving the 3 anatomical compartments of the neck, mediastinum, and abdomen was introduced as an important component of a curative esophageal resection in the early 1980s in Japan, and has been reported to be effective for improving not only the staging accuracy, but also the long-term survival in patients with esophageal cancer, with the average 5-year survival rate being 40 to 60%. At present, 63% of all Japanese patients with esophageal cancer undergo an esophagectomy. Of these patients undergoing surgery, a 3-field and a conventional 2-field lymphadenectomy is performed in 35% and 33%, respectively. Alternatively, a transhiatal esophagectomy without a systematic lymphadenectomy has become one of the preferred types of surgery for patients with esophageal cancer in Western countries. An Appropriate Esophagectomy for Esophageal Cancer: A Lack of Evidence and a Growing Disparity between Western and Eastern Standards
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