Background Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting. Methods Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.). Results Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome. Conclusion Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Background The Esophagectomy Complications Consensus Group (ECCG) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA) have set standards in reporting outcomes after oesophagectomy. Reporting outcomes from selected high-volume centres or centralized national cancer programmes may not, however, be reflective of the true global prevalence of complications. This study aimed to compare complication rates after oesophagectomy from these existing sources with those of an unselected international cohort from the Oesophago-Gastric Anastomosis Audit (OGAA). Methods The OGAA was a prospective multicentre cohort study coordinated by the West Midlands Research Collaborative, and included patients undergoing oesophagectomy for oesophageal cancer between April and December 2018, with 90 days of follow-up. Results The OGAA study included 2247 oesophagectomies across 137 hospitals in 41 countries. Comparisons with the ECCG and DUCA found differences in baseline demographics between the three cohorts, including age, ASA grade, and rates of chronic pulmonary disease. The OGAA had the lowest rates of neoadjuvant treatment (OGAA 75.1 per cent, ECCG 78.9 per cent, DUCA 93.5 per cent; P < 0.001). DUCA exhibited the highest rates of minimally invasive surgery (OGAA 57.2 per cent, ECCG 47.9 per cent, DUCA 85.8 per cent; P < 0.001). Overall complication rates were similar in the three cohorts (OGAA 63.6 per cent, ECCG 59.0 per cent, DUCA 62.2 per cent), with no statistically significant difference in Clavien–Dindo grades (P = 0.752). However, a significant difference in 30-day mortality was observed, with DUCA reporting the lowest rate (OGAA 3.2 per cent, ECCG 2.4 per cent, DUCA 1.7 per cent; P = 0.013). Conclusion Despite differences in rates of co-morbidities, oncological treatment strategies, and access to minimal-access surgery, overall complication rates were similar in the three cohorts.

Background The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. Methods Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. Results Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). Conclusion Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.

Aim: To explore the effects of dexmedetomidine infusion combined with lignocaine on the intraoperative hemodynamic profile. Study Design: randomized, double-blind study Place and Duration of Study: Department of Anesthesia, Isra University Hospital, Hyderabad from 1st May 2021 to 31st October 2021. Methodology: Sixty patients from the daily operation list were randomly assigned to group D (dexmedetomidine intravenous infusion only) and group LD (dexmedetomidine plus lignocaine intravenous infusion) using a sealed envelope system. Results: The majority of the patients presented ASA status II (41.7%) were in the age group of 35-44 years (23.3%) and had BMI ranging from 25-34. Analysis of various clinical parameters showed a significant difference between group D and LD in terms of reduced heart rate, average mean arterial pressure, and need for transfusion. A higher number of patients receiving combination infusion had negligible blood loss with reference to patients maintained at dexmedetomidine alone. The satisfaction levels of the surgeon and attending anesthetist were significantly higher for surgical outcomes in the group receiving a combinative infusion of dexmedetomidine and lignocaine. Conclusion: The hemodynamic profiles of patients undergoing different surgeries showed significant favor for the combination of dexmedetomidine and lignocaine infusion as compared to infusion of dexmedetomidine only. Keywords: Deliberate hypotension, Intraoperative, Hemodynamic, Dexmedetomidine, Lignocaine

Objective: Aim of current is to determine the efficacy of darn repair technique in the management of indirect inguinal hernia in terms of complications and recurrence rate among patients. Study Design: Prospective study Place and Duration: The study was conducted at Surgery department of Combined Military Hospital, Sargodha and DHQ Hospital, KharBajaur during the period from January 2021 to June 2021. Methods: There were sixty males who had indirect inguinal hernia included in this study. Included patients had age between 18-80 years. After receiving informed written agreement, the demographics of enrolled patients were recorded, including age, BMI, and side of hernia. All the patients were treated with darning method. Post-operative complications, hospital stay and recurrence rate among patients were assessed. We used the SPSS 24.0 version to analyze all data. Results: Among 60 cases, 10 (16.7%) were aged between 18-30 years, 12 (20%) patients were from age group 31-40 years and most of the patients 38 (63.3%) had age >40 years. We found most of the cases had right side hernia 34 (56.7%), 20 (33.3%) cases had left and bilateral cases were 6 (10%). Majority of the cases had reducible hernia 48 (80%) and emergency treatment was given to irreducible cases 12 (20%). General anesthesia was mostly used among 44 (73.3%) cases. The mean operative time was 55.3±9.43 minutes and mean hospitalization was 30.3±7.33 hours. We found recurrence rate only among 2 (3.3%) cases and frequency of complications were 8 (13.3%). Conclusion: We concluded in this study that darning method for the management of indirect inguinal hernia is effective and useful in terms of less post-operative complications and recurrence rate. Keywords: Inguinal Hernia, Darn Method, Anesthesia, Complications, Recurrence Rate