ANZ journal of surgery · 2025
Ten-year review of oesophagectomy in a regional New Zealand hospital: making the case for a low-volume centre.
СтатьяНазвание и аннотация: Перевод в очереди
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Anderson Cain, Veitch Rebecca, Lekamalage Binura, Mafi Daniel, Rossaak Jeremy, Smith Barnaby, Patel Riteshkumar
Аннотация
BACKGROUND: Oesophageal cancer is a highly aggressive malignancy with poor survival rates. The treatment approach is multimodal, employing endoscopy and chemoradiotherapy; however, surgical resection remains a mainstay of management. Centres with high volumes of resections are associated with improved outcomes, but an optimal number for annual caseload is not defined. International benchmarks for morbidity and mortality have been established by the Oesophageal Complications Consensus Group (ECCG) using data from high-volume centres. This study compared data from a New Zealand low-volume centre against these.
METHODS: This retrospective study included all patients undergoing oesophagectomy at Tauranga Hospital between 2014 and 2023, with primary analysis comparing mortality and complications to the ECCG benchmarks. Secondary analysis stratified data by age, ethnicity, comorbidity, and preoperative treatment.
RESULTS: Sixty-one patients underwent oesophagectomy, with a 30-day mortality of 0% and a 90-day mortality of 1.6%, both below the ECCG benchmarks. However, complication rates were higher, with anastomotic leak (16.4%) and Clavien-Dindo ≥3B complications (26.2%) exceeding the benchmark rates. There were no significant differences in outcomes stratified by demographic or clinical subgroups.
CONCLUSION: This study finds better mortality outcomes and poorer morbidity outcomes than the benchmark. These results suggest that low-volume centres which concurrently perform similar complex oncological resections and have access to dedicated Intensive Care, interventional radiology, and endoscopy may have comparable results to high-volume centres. If similar centres achieve good outcomes, consideration must be given to keeping regional oesophagectomy services to reduce inequities and improve access to healthcare.
METHODS: This retrospective study included all patients undergoing oesophagectomy at Tauranga Hospital between 2014 and 2023, with primary analysis comparing mortality and complications to the ECCG benchmarks. Secondary analysis stratified data by age, ethnicity, comorbidity, and preoperative treatment.
RESULTS: Sixty-one patients underwent oesophagectomy, with a 30-day mortality of 0% and a 90-day mortality of 1.6%, both below the ECCG benchmarks. However, complication rates were higher, with anastomotic leak (16.4%) and Clavien-Dindo ≥3B complications (26.2%) exceeding the benchmark rates. There were no significant differences in outcomes stratified by demographic or clinical subgroups.
CONCLUSION: This study finds better mortality outcomes and poorer morbidity outcomes than the benchmark. These results suggest that low-volume centres which concurrently perform similar complex oncological resections and have access to dedicated Intensive Care, interventional radiology, and endoscopy may have comparable results to high-volume centres. If similar centres achieve good outcomes, consideration must be given to keeping regional oesophagectomy services to reduce inequities and improve access to healthcare.