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 aim of our study was to use a modified Delphi process to determine the research priorities amongst benign upper gastrointestinal (UGI) surgeons in the United Kingdom. Methods Delphi methodology may be utilised to develop consensus opinion amongst a group of experts. Members of the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland were invited to submit individual research questions via an online survey (phase I). Two rounds of prioritisation by multidisciplinary expert healthcare professionals (phase II and III) were completed to determine a final list of high-priority research questions.Results Four hundred and twenty-seven questions were submitted in phase I, and 51 with a benign UGI focus were taken forward for prioritisation in phase II. Twenty-eight questions were ranked in phase III. A final list of 11 highpriority questions had an emphasis on acute pancreatitis, Barrett's oesophagus and benign biliary disease. Conclusion A modified Delphi process has produced a list of 11 high-priority research questions in benign UGI surgery. Future studies and awards from funding bodies should reflect this consensus list of prioritised questions in the interest of improving patient care and encouraging collaborative research.

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.

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Background Leiomyomas are rare, benign submucosal tumours originating from smooth muscle cells. Ulcerated lesions could present with Upper Gastrointestinal(UGI) bleeding. Treatment of these lesion could be challenging especially if they are close to the Oesophagogastric Junction(OGJ). In this abstract, we present a novel surgical technique for resection of symptomatic gastric submucosal lesion located near the gastro-oesophageal junction on the lesser curve of the stomach. The Endoscopy guided laparoscopic trans-gastric resection technique is minimally invasive and avoids partial or total gastrectomy. Methods We present a case of 74-year-old male with a body mass index of 32.3 requiring resection of a bleeding gastric submucosal lesion. The patient presented with melaena, and an upper GI endoscopy diagnosed a single 30mm sub mucosal tumour immediately distal to the gastro-oesophageal junction. Stable clinical condition allowed complete preoperative work out including staging CT that showed small lesion at OGJ with no evidence of metastasis. UGI MDT discussion advised surgery without Endoscopic Ultrasound as it was a bleeding lesion. The patient was consulted on the management options and decided on surgical resection for prevention of re-bleeding. Surgical options discussed included local resection, partial and or total gastrectomy. Endoscopy was performed under general anaesthetic at the time of surgery and the tumour was found to be on the upper part of lesser curvature, thus not suitable for wedge or sleeve gastrectomy. A decision was made to try the trans-gastric approach. Results The endoscope was left in the stomach to demonstrate and protect the gastro-oesophageal junction. A gastrotomy was made longitudinally on the anterior surface of the stomach. Careful assessment of the lesion suggested that it could be resected using the trans-gastric approach. The endoscope was used to protect the junction and an endoscopic stapler (Echelon flex 60mm, Gold) was used to resect the tumour. A nasogastric drainage tube (NGT) was placed under vision and the gastrostomy was closed with the Echelon flex stapler 60 mm gold and blue . The NGT left for 72 hours with restricted and controlled fluid intake started the day after surgery and gradually increased to soft diet over three days. Patient was discharged on day 4. Follow up on day 7; WBC 10, CRP 19 and patient was very satisfied that he is at home and eating now normal diet. Using this minimally invasive approach we achieved macroscopic complete resection of the tumour whilst avoiding a total gastrectomy. Pathology report concluded features are of a smooth muscle tumour favouring a benign leiomyoma that is fully excised. Repeat scope after 3 month showed good healing and no recurrence or stricture and patient remains asymptomatic. Conclusions In this abstract we present endoscopic guided laparoscopic trans gastric resection (ELTGR) approach as a novel technique to avoid laparoscopic or open proximal gastrectomy or total gastrectomy in patients with tumours adjacent to the gastro-oesophageal junction and on the lesser curve that do not require radical oncological resection.