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)

Abstract

Background 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). Methods 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. Results 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). Conclusion 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.

From open Ivor Lewis esophagectomy to a hybrid robotic-assisted thoracoscopic approach: a single-center experience over two decades

“…This is consistent with previously published studies comparing similar surgical techniques [21]. Moreover, our rates of complications such as anastomotic leaks, surgical reinterventions, and mortality for both Rob-E and Open-E are comparable to data from benchmarking reports [22,23]. For this study, the definition of anastomotic leakage is an endoscopically proven leakage.…”

Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

“…Complications in the immediate postoperative period speci c to esophagectomy (airway stula, volvulus or necrosis of the gastric graft, thoracic duct injury, recurrent bilateral paralysis of the nerve) may in some cases require emergency reoperation [21].…”

Evaluation of the use of inflammatory biomarkers in the early detection of anastomotic leakage after esophagectomy: A retrospective analysis

“…Postoperative anastomotic leakage (AL) remains one of the major complications of esophagectomy in both high- and low-volume centers worldwide. In a recent cross-sectional study performed by the Oesophago-Gastric Anastomosis Study Group, data collected from 2,247 esophagectomies across 137 hospitals in 41 countries revealed a rate of AL of 14.6% [ 2 ]. AL has a drastic effect on the early mortality rates, prolonged hospital stay, and increased cost of treatment [ 3 ].…”