BACKGROUND

Oesophagectomy remains the mainstay of treatment for patients with potentially curable malignancy of the oesophagus or OGJ and for selected patients with benign disease. Oesophagectomy is associated with significant morbidity and occasional operative mortality. In the absence of registers of oesophagectomies or collaborative databases it behoves institutions in Australia and New Zealand to publish and present peri-operative morbidity and mortality data for peer review. Demonstrated correlations between hospital/surgeon resection volume and outcome have driven moves towards centralisation of cancer surgery.

AIM

The aim of this study is to audit the results of oesophagogastric (OG) resection in a newly established “high volume” OG surgical unit in Australia.

METHODS

Clinical, operative and pathological data for patients undergoing OG resection at our institution were recorded prospectively on an electronic database.
Key indicators of care standards were examined including peri-operative mortality and morbidity, unscheduled return to theatre, anastomotic failure and oncological parameters. These were compared to “acceptable” rates in the literature.

RESULTS

Between December 2001 and May 2012, 150 patients underwent oesophagectomy. 134 for primary malignancy of the oesophagus, 10 for high grade dysplasia in Barrett’s oesophagus, and 6 for other indications. 148 were elective procedures, 2 emergencies for perforation. 81 cases were performed by Ivor Lewis oesophagectomy, 65 via hybrid minimally invasive technique(thoracoscopy and laparotomy), 2 total minimally invasive(thoracoscopy and laparoscopy), and 2 patients underwent oesophagectomy and gastrectomy. Overall operative mortality was 2.0%(3/150). Median length-of-stay was 15 days. There were 14 unscheduled returns to theatre. For the 134 cancer patients, the mean resected lymph node count was 19(range 5-41). There were 28(20.9%) cases of positive circumferential margins. Median overall survival in the cancer group was 42.6 months, 5-year overall survival of 37%.

CONCLUSION

The outcome parameters reported above are consistent with units performing high volume of OG resection. How such data contribute to the debate surrounding centralisation remains to be determined.