A Population-based Study on Lymph Node Retrieval in Patients with Esophageal Cancer: Results from the Dutch Upper Gastrointestinal Cancer Audit

Werf, Leonie R. van der; Dikken, Johan L.; Henegouwen, Mark I. van Berge; Lemmens, Valery; Nieuwenhuijzen, G.; Wijnhoven, Bas P. L.

doi:10.1245/s10434-018-6396-7

Cited by 40 publications

(24 citation statements)

References 22 publications

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“…In the current study, transthoracic surgery was associated with prolonged length of hospital stay which is in line with the results of a large meta-analyses comparing transhiatal and transthoracic surgery [34]. The opening of the thorax and more extensive lymph node dissection of transthoracic surgery might require longer in-hospital recovery independent of complications [35]. This study also showed shorter length of hospital stay in high-volume hospitals.…”

Section: Discussionsupporting

confidence: 89%

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

et al. 2020

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Background Within the scope of value-based health care, this study aimed to analyze Dutch hospital performance in terms of length of hospital stay after esophageal cancer surgery and its association with 30-day readmission rates. Since both parameters are influenced by the occurrence of complications, this study only included patients with an uneventful recovery after esophagectomy. Methods All patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) who underwent a potentially curative esophagectomy between 2015 and 2018 were considered for inclusion. Patients were excluded in case of an intraoperative/post-operative complication, readmission to the intensive care unit, or any re-intervention. Length of hospital stay was dichotomized around the national median into ‘short admissions’ and ‘long admissions’. Hospital variation was evaluated using a case-mix-corrected funnel plot based on multivariable logistic regression analyses. Association of length of hospital stay with 30-day readmission rates was investigated using the χ2-statistic. Results A total of 1007 patients was included. National median length of hospital stay was 9 days, ranging from 6.5 to 12.5 days among 17 hospitals. The percentage of ‘short admissions’ per hospital ranged from 7.7 to 93.5%. After correction for case-mix variables, 3 hospitals had significantly higher ‘short admission’ rates and 4 hospitals had significantly lower ‘short admission’ rates. Overall, 6.2% [hospital variation (0.0–13.2%)] of patients were readmitted. Hospital 30-day readmission rates were not significantly different between patients with a short length of hospital stay and those with a long length of hospital stay (5.5% versus 7.6%; p = 0.19). Conclusions Based on these nationwide audit data, median length of hospital stay after an uncomplicated esophagectomy was 9 days ranging from 6.5 to 12.5 days among Dutch hospitals. There was no association between length of hospital stay and readmission rates. Nationwide improvement might lead to a substantial reduction of hospital costs.

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Section: Discussionsupporting

confidence: 89%

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

et al. 2020

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“…More recently, the Dutch Upper Gastrointestinal Cancer Audit reported that 69% of oesophagectomy patients had a node yield of at least 15 nodes 12. This demonstrates a common difficulty in achieving a minimum node yield in oesophagogastric resections and, together with our data, supports the use of techniques to increase lymph node yield, at least selectively, in clinical practice.…”

Section: Discussionsupporting

confidence: 79%

Fat clearance of upper gastrointestinal resection specimens increases lymph node yield and may result in nodal upstaging

2018

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IntroductionLymph node retrieval and quantification is an important element in staging upper gastrointestinal cancers. Our department introduced fat clearance for oesophagectomy and gastrectomy specimens in 2014. This study assessed the impact of this change on lymph node yield and upstaging.MethodsWe reviewed histopathology data for upper gastrointestinal resection specimens. Patient demographics, clinical, macroscopic and microscopic data were compared with a historical cohort who did not undergo fat clearance.ResultsOf 158 patients, 133 resection specimens received fat clearance resulting in a significantly higher lymph node yield than the historical cohort (22 vs 13 lymph nodes, p<0.0001). Fat clearance found additional positive nodes in 24.1% of patients and increased the number of cases achieving a minimum node yield of 15. Nodes found by fat clearance caused upstaging in 15% of the cohort.DiscussionFat clearance increases node yield in upper gastrointestinal resection specimens and may cause nodal upstaging.

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“…From previous studies with DUCA data, it is known that higher age, ASA score, body mass index, Nþ status, proximal-mid esophageal tumorlocation, and open transthoracic procedures are associated with an increased risk for postoperative complications. 8,9 Some of these factors were more frequently present in the DUCA, for example, 30% of patients were older than 70 years old (vs 23% in the ECCG cohort). However, in the ECCG cohort, patients with ASA III or higher were more frequently present then in the DUCA (39% vs 21%).…”

Section: Discussionmentioning

confidence: 99%

Reporting National Outcomes After Esophagectomy and Gastrectomy According to the Esophageal Complications Consensus Group (ECCG)

et al. 2019

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Objective: This nationwide population-based study aimed to report postoperative morbidity and mortality after esophagectomy and gastrectomy in the Netherlands according to the definitions of the Esophagectomy Complications Consensus Group (ECCG). Background: To standardize international outcome reporting in esophageal surgery, the ECCG developed a standardized outcomes set. Methods: For this national cohort study, all patients undergoing esophagectomy or gastrectomy for cancer between 2016 and 2017 were selected from the Dutch Upper gastrointestinal Cancer Audit. In a random sample of hospitals, data completeness and accuracy were validated by reabstraction of the data. The investigated outcomes in the present study were postoperative complications, major complications (Clavien-Dindo grade !III), and 30-day mortality, according to definitions of the ECCG. Results: A total of 2545 patients from 22 hospitals were included. The completeness of the Dutch Upper gastrointestinal Cancer Audit was estimated at 99.8%. Data accuracy on different items was 94% to 100%. After esophagectomy, 1046 of 1617 patients (65%) had a postoperative complication including 468 patients (29%) with a major complication. Most common complications were pneumonia (21%), esophago-enteric leak from anastomosis, staple line or localized conduit necrosis (19%), and atrial dysrhythmia (15%). The 30-day mortality was 1.7%. After gastrectomy, 397 of 928 patients (42%) had a postoperative complication including 180 patients (19%) with a major complication. Most common complications were pneumonia (12%), esophago-enteric leak from anastomosis, staple line or localized conduit necrosis (9%), and acute delirium (5%). The 30-day mortality was 4.4%. Conclusions: Reporting complications according to the ECCG platform is feasible in the Netherlands and facilitates international benchmarking.

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A Population-based Study on Lymph Node Retrieval in Patients with Esophageal Cancer: Results from the Dutch Upper Gastrointestinal Cancer Audit

Cited by 40 publications

References 22 publications

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

Fat clearance of upper gastrointestinal resection specimens increases lymph node yield and may result in nodal upstaging

Reporting National Outcomes After Esophagectomy and Gastrectomy According to the Esophageal Complications Consensus Group (ECCG)

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