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

Abstract

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.

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

“…Early mortality following major oesophagogastric resection has continued to decrease in recent years, and the 30‐ and 90‐day mortality rates, complication rates, leak rate and recurrence rate reported in this cohort are all comparable to national outcomes recorded over this interval by the British National Oesophagogastric Cancer Audit and other series. The present cohort had a shorter median OS (32·3 versus 43–54 months) and DFS (26·3 versus 40–48 months) than reported in the contemporary international literature.…”

“…The Esophagectomy Complications Consensus Group (ECCG) has provided a standardized platform for reporting complications following oesophagogastric resection, and in 2019 reported benchmarking of complication prevalence in a 2015–2016 cohort. The overall incidence of any complication in the present cohort (39·0 per cent) was lower than that reported by the ECCG (59 per cent).…”

Postoperative intensive care unit stay after minimally invasive esophagectomy shows large hospital variation. Results from the Dutch Upper Gastrointestinal Cancer Audit

“…(Neo) adjuvant chemo (radio)therapy followed by surgical resection is the cornerstone of curative treatment. Esophagectomy is associated with postoperative complication rates of around 65%, severe complications (Clavien-Dindo grade III or higher) occur in 29% of patients [3]. Due to the invasive nature of esophageal cancer surgery, patients were routinely admitted to the intensive care unit (ICU) for hemodynamic support, pain management or respiratory support [4].…”

Efficacy of Indocyanine Green Fluorescence Angiography in Preventing Anastomotic Leakage After McKeown Minimally Invasive Esophagectomy

“…Esophagectomy is an invasive and complicated procedure, and the frequency of postoperative complications is as high as 59% ( 5 ). Anastomotic leakage (AL) after esophagectomy is one of the most dreaded postoperative complications, and is responsible for higher postoperative morbidity and mortality rates, prolonged hospital stays, and the need for further surgical procedures ( 6 , 7 ).…”