Hp27
mortality, Morbidity and 2 Year Survival Following Oesophagectomy – Dunedin Experience

Abstract

Purpose Oesophagectomy is associated with considerable morbidity, mortality and poor survival of patients who have undergone oesophagectomy for oesophageal carcinoma. Numerous studies have examined the impact of hospital volume on early mortality, most demonstrating a strong inverse relationship between operative mortality and hospital case volume. This study looks at the morbidity, mortality and 2‐year survival of patients following oesophagectomy at Dunedin hospital, a low volume centre, and comparing it to high volume centres. Methods A retrospective analysis of all patients who had elective oesophagectomy between 1995 and 2004. Otago Surgical Audit database, patient management system database (OraCare) as well as operating theatre database were used. Results 40 patients were identified, which had either transhiatal or Ivor‐Lewis procedure. 50% had pre‐op chemotherapy and 33% pre‐op radiotherapy. 65% had adenocarcinoma, 10% squamous cell carcinoma and 15% had Barrett’s with severe dysplasia. The mortality at Dunedin was 5%. Complications were: respiratory 37.5%, leak 10%, wound 22.5%, oesophageal stricture 2.5% and chylothorax 2.5%. Median length of stay was 15 days (11–94). Median survival of patients with oesophageal carcinoma was 26 months. Median survival of node negative patients was 34.5 months and node positive patients 14 months. Conclusion Prognosis for patients with node‐positive disease continues to be poor despite oesophagectomy. The complication rates and in‐hospital mortality at Dunedin are similar to high volume centres. This study shows that patients undergoing oesophagectomy at low volume hospital do not have increased risk of operative mortality.

Safety and outcomes after oesophagectomy in southern New Zealand: a 25‐year audit of a low volume centre

“…Diligent prospective surgical audit is axiomatic. In fact, the SDHB oesophagectomy outcomes have been audited previously in 2007 and 2014 and the results presented at international meetings 28,29 …”

Oesophagectomy at a New Zealand regional centre: where to now?

“…Three hundred patients are diagnosed annually, and 270 will die within 24 months of diagnosis. 5,6 However, oesophagectomy has been poorly studied in New Zealand with the first publication recorded in 1961 7 followed by publications from Wellington, 8 Dunedin, 9 Palmerston North [10][11][12] and Christchurch, 13,14 and no designated regional or national referral centres exist. However, the procedure is associated with significant morbidity 3 and care of patients following oesophagectomy requires access to significant resources, including intensive care, interventional radiology and advanced endoscopy 4 and concentrating patients requiring oesophagectomy in single high-volume centres may lead to improved outcomes.…”

“…However, the procedure is associated with significant morbidity 3 and care of patients following oesophagectomy requires access to significant resources, including intensive care, interventional radiology and advanced endoscopy 4 and concentrating patients requiring oesophagectomy in single high-volume centres may lead to improved outcomes. 5,6 However, oesophagectomy has been poorly studied in New Zealand with the first publication recorded in 1961 7 followed by publications from Wellington, 8 Dunedin, 9 Palmerston North [10][11][12] and Christchurch, 13,14 and no designated regional or national referral centres exist.…”