Cargando…

Evaluation of oesophageal and gastric resection outcomes in a small-volume unit

INTRODUCTION: Oesophagogastric resections continue to be a major surgical challenge with high morbidity, this has led to a worldwide trend for centralisation of these complex surgeries. However, there is no clear agreement on what constitutes a high-volume centre, leading to worldwide disparity. We...

Descripción completa

Detalles Bibliográficos
Autores principales: Hassn, Ahmed, Gupta, Ashish, Ramadan, Mohamed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220169/
https://www.ncbi.nlm.nih.gov/pubmed/34188911
http://dx.doi.org/10.1016/j.amsu.2021.102499
_version_ 1783711091194331136
author Hassn, Ahmed
Gupta, Ashish
Ramadan, Mohamed
author_facet Hassn, Ahmed
Gupta, Ashish
Ramadan, Mohamed
author_sort Hassn, Ahmed
collection PubMed
description INTRODUCTION: Oesophagogastric resections continue to be a major surgical challenge with high morbidity, this has led to a worldwide trend for centralisation of these complex surgeries. However, there is no clear agreement on what constitutes a high-volume centre, leading to worldwide disparity. We evaluate our experience of oesophagogastric resection in a small volume unit to seek other factors that influence patient outcome. METHODS: We analysed 173 consecutive oesophagogastric resection from 2010 to 2020. The primary outcome was 30-day mortality and secondary outcome included peri-operative morbidity, length of stay, lymph node harvest, R0 resection. Collected continuous data were compared using the Mann-Whitney test and categorical data using the chi-squared test and expressed as p value. RESULTS: Of the 173 patients, 94 (54%) underwent hybrid minimal invasive esophagectomy (HIMO) and 79 (46%) underwent gastrectomy. 135 (78%) patients received Neoadjuvant therapy. The site of tumour was GOJ in 29%, distal stomach in 26% and distal oesophagus in 20%. Perioperative morbidity was observed in 18 (19%) after esophagectomy and 9 (11.4%) after gastrectomy. The median lymph node harvest was 18 (range 5–42) and 168 patients (97%) had longitudinal R0 resection. The most common complication was neurological seen in 3.6% followed by pulmonary complication and anastomotic leak seen in 5 patients (3%) each. The median in hospital stay was 6 days and the 30 day mortality was 2.9% with one year survival of 87%. CONCLUSION: Small volume centres can produce comparable results. The outcomes depend on multifold parameters which include surgeon's experience in the field, ability to adhere to protocols and procedures and strong interpersonal relationship with individual patients.
format Online
Article
Text
id pubmed-8220169
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-82201692021-06-28 Evaluation of oesophageal and gastric resection outcomes in a small-volume unit Hassn, Ahmed Gupta, Ashish Ramadan, Mohamed Ann Med Surg (Lond) Cross-sectional Study INTRODUCTION: Oesophagogastric resections continue to be a major surgical challenge with high morbidity, this has led to a worldwide trend for centralisation of these complex surgeries. However, there is no clear agreement on what constitutes a high-volume centre, leading to worldwide disparity. We evaluate our experience of oesophagogastric resection in a small volume unit to seek other factors that influence patient outcome. METHODS: We analysed 173 consecutive oesophagogastric resection from 2010 to 2020. The primary outcome was 30-day mortality and secondary outcome included peri-operative morbidity, length of stay, lymph node harvest, R0 resection. Collected continuous data were compared using the Mann-Whitney test and categorical data using the chi-squared test and expressed as p value. RESULTS: Of the 173 patients, 94 (54%) underwent hybrid minimal invasive esophagectomy (HIMO) and 79 (46%) underwent gastrectomy. 135 (78%) patients received Neoadjuvant therapy. The site of tumour was GOJ in 29%, distal stomach in 26% and distal oesophagus in 20%. Perioperative morbidity was observed in 18 (19%) after esophagectomy and 9 (11.4%) after gastrectomy. The median lymph node harvest was 18 (range 5–42) and 168 patients (97%) had longitudinal R0 resection. The most common complication was neurological seen in 3.6% followed by pulmonary complication and anastomotic leak seen in 5 patients (3%) each. The median in hospital stay was 6 days and the 30 day mortality was 2.9% with one year survival of 87%. CONCLUSION: Small volume centres can produce comparable results. The outcomes depend on multifold parameters which include surgeon's experience in the field, ability to adhere to protocols and procedures and strong interpersonal relationship with individual patients. Elsevier 2021-06-11 /pmc/articles/PMC8220169/ /pubmed/34188911 http://dx.doi.org/10.1016/j.amsu.2021.102499 Text en © 2021 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Cross-sectional Study
Hassn, Ahmed
Gupta, Ashish
Ramadan, Mohamed
Evaluation of oesophageal and gastric resection outcomes in a small-volume unit
title Evaluation of oesophageal and gastric resection outcomes in a small-volume unit
title_full Evaluation of oesophageal and gastric resection outcomes in a small-volume unit
title_fullStr Evaluation of oesophageal and gastric resection outcomes in a small-volume unit
title_full_unstemmed Evaluation of oesophageal and gastric resection outcomes in a small-volume unit
title_short Evaluation of oesophageal and gastric resection outcomes in a small-volume unit
title_sort evaluation of oesophageal and gastric resection outcomes in a small-volume unit
topic Cross-sectional Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220169/
https://www.ncbi.nlm.nih.gov/pubmed/34188911
http://dx.doi.org/10.1016/j.amsu.2021.102499
work_keys_str_mv AT hassnahmed evaluationofoesophagealandgastricresectionoutcomesinasmallvolumeunit
AT guptaashish evaluationofoesophagealandgastricresectionoutcomesinasmallvolumeunit
AT ramadanmohamed evaluationofoesophagealandgastricresectionoutcomesinasmallvolumeunit