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Langenbeck's Archives of Surgery

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01-09-2016 | ORIGINAL ARTICLE

Perioperative outcomes of esophageal cancer surgery in a mid-volume institution in the era of centralization

Authors: Silvio Däster, Savas D. Soysal, Luca Koechlin, Lea Stoll, Ralph Peterli, Markus von Flüe, Christoph Ackermann

Published in: Langenbeck's Archives of Surgery | Issue 6/2016

Abstract

Background

Centralization of esophageal cancer surgery to high-volume institutions has been shown to improve perioperative outcomes in several studies. However, there is an ongoing debate, whether defined minimal annual hospital volumes for esophagectomies are required for quality assurance. The aim of the study was to assess perioperative outcomes of esophagectomies in a single institution in Switzerland.

Methods

Data from a database of esophagectomies performed between 2004 and 2013 was analyzed. Perioperative morbidity of esophagectomies due to cancer was assessed according to the Clavien-Dindo classification. Postoperative mortality was defined as death from any cause within the same hospital stay.

Results

A total of 143 operations (125 transthoracic esophagectomies, 18 extended transhiatal gastrectomies) were performed in the surveyed 10-year period. Two surgeons performed 91 % of all procedures. Postoperative morbidity was 43.4 %. Complications with a Clavien-Dindo score of III/IV (requiring surgical, endoscopic, or radiological intervention) occurred in 19 cases (13.4 %). The overall anastomotic leak rate was 3.5 %. Pulmonary complications were the most frequent postoperative problems involving 21 % of patients. In-hospital mortality was 0.7 %. Mean length of hospital stay was 17 days in patients with no complications and 22 days if there were any complications (p < 0.001).

Conclusion

Esophageal cancer surgery is complex and has a significant risk of morbidity. The most common postoperative problems are pulmonary complications, usually responding well to non-invasive treatment. Appropriate patient selection and preparation, high surgeon volume, and a comprehensive multidisciplinary care pathway can provide a low perioperative mortality rate in a mid-volume institution.

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Title: Perioperative outcomes of esophageal cancer surgery in a mid-volume institution in the era of centralization
Authors: Silvio Däster
Savas D. Soysal
Luca Koechlin
Lea Stoll
Ralph Peterli
Markus von Flüe
Christoph Ackermann
Publication date: 01-09-2016
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 6/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1477-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perioperative outcomes of esophageal cancer surgery in a mid-volume institution in the era of centralization

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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