Failure to Rescue from Surgical Complications After Trans-thoracic and Trans-hiatal Esophageal Resection: an ACS-NSQIP Study

Oh, Kenny; Gajdos, Csaba; Savulionyte, Goda; Hennon, Mark; Schwaitzberg, Steven D.; Nader, Nader D.

doi:10.1007/s11605-020-04797-y

Cited by 5 publications

(1 citation statement)

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“…In addition, centralization must be accompanied by transparent outcome assessment via national audits and audited multicenter registries. Ideally, outcomes should be measured with well-defined parameters such as complication, mortality and readmission rates, failure to rescue (percentage of patients with a postoperative complication who die as a result of it), textbook outcome (percentage of patients who meet a series of ideal perioperative outcomes) and benchmarking [ 89 , 103 ]. Therefore, as pointed out by D. Low in his landmark publication, specialized upper-GI units with a specific and inherent interest in outcome research are in the best position to meet the future requirements of esophageal cancer surgery centralization [ 14 ].…”

Section: Future Perspectivesmentioning

confidence: 99%

Surgical Therapy of Esophageal Adenocarcinoma—Current Standards and Future Perspectives

Schröder

Gisbertz

Voeten

et al. 2021

Cancers

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Transthoracic esophagectomy is currently the predominant curative treatment option for resectable esophageal adenocarcinoma. The majority of carcinomas present as locally advanced tumors requiring multimodal strategies with either neoadjuvant chemoradiotherapy or perioperative chemotherapy alone. Minimally invasive, including robotic, techniques are increasingly applied with a broad spectrum of technical variations existing for the oncological resection as well as gastric reconstruction. At the present, intrathoracic esophagogastrostomy is the preferred technique of reconstruction (Ivor Lewis esophagectomy). With standardized surgical procedures, a complete resection of the primary tumor can be achieved in almost 95% of patients. Even in expert centers, postoperative morbidity remains high, with an overall complication rate of 50–60%, whereas 30- and 90-day mortality are reported to be <2% and <6%, respectively. Due to the complexity of transthoracic esophagetomy and its associated morbidity, esophageal surgery is recommended to be performed in specialized centers with an appropriate caseload yet to be defined. In order to reduce postoperative morbidity, the selection of patients, preoperative rehabilitation and postoperative fast-track concepts are feasible strategies of perioperative management. Future directives aim to further centralize esophageal services, to individualize surgical treatment for high-risk patients and to implement intraoperative imaging modalities modifying the oncological extent of resection and facilitating surgical reconstruction.

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Section: Future Perspectivesmentioning

confidence: 99%