International benchmarking in oesophageal and gastric cancer surgery

Busweiler, Linde A. D.; Jeremiasen, Martin; Wijnhoven, Bas P. L.; Lindblad, Mats; Lundell, Lars; Velde, Cornelis J.H. van de; Tollenaar, Rob A.E.M.; Wouters, Michel W. J. M.; Sandick, Johanna W. van; Johansson, Jan; Dikken, Johan L.

doi:10.1002/bjs5.50107

Cited by 29 publications

(40 citation statements)

References 36 publications

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“…Between 2011 and 2016, of all gastrectomies for gastric cancer with curative intent, in 9–13% the tumors were incompletely removed 3. This number corresponds with other European outcome registries 4,5. The British National Oesophago-Gastric Cancer Audit (NOGCA) reported that up to 29% of the gastrectomies performed in individual hospitals had tumor-positive margins 5.…”

supporting

confidence: 62%

Population-Based Study on Risk Factors for Tumor-Positive Resection Margins in Patients with Gastric Cancer

et al. 2019

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Background Radical gastrectomy is the cornerstone of the treatment of locally advanced gastric cancer. This study was designed to evaluate factors associated with a tumor-positive resection margin after gastrectomy and to evaluate the influence of hospital volume. Methods In this Dutch cohort study, patients with junctional or gastric cancer who underwent curative gastrectomy between 2011 and 2017 were included. The primary outcome was incomplete tumor removal after the operation defined as the microscopic presence of tumor cells at the resection margin. The association of patient and disease characteristics with incomplete tumor removal was tested with multivariable regression analysis. The association of annual hospital volume with incomplete tumor removal was tested and adjusted for the patient- and disease characteristics. Results In total, 2799 patients were included. Incomplete tumor removal was seen in 265 (9.5%) patients. Factors associated with incomplete tumor removal were: tumor located in the entire stomach (odds ratio (OR) [95% confidence interval (CI): 3.38 [1.91–5.96] reference: gastroesophageal junction), cT3, cT4, cTx (1.75 [1.20–2.56], 2.63 [1.47–4.70], 1.60 [1.03–2.48], reference: cT0-2), pN+ (2.73 [1.96–3.80], reference: pN−), and diffuse and unknown histological subtype (3.15 [2.14–4.46] and 2.05 [1.34–3.13], reference: intestinal). Unknown differentiation grade was associated with complete tumor removal (0.50 [0.30–0.83], reference: poor/undifferentiated). Compared with a hospital volume of < 20 resections/year, 20–39, and > 39 resections were associated with lower probability for incomplete tumor removal (OR 0.56 [0.42–0.76] and 0.34 [0.18–0.64]). Conclusions Tumor location, cT, pN, histological subtype, and tumor differentiation are associated with incomplete tumor removal. The association of incomplete tumor removal with an annual hospital volume of < 20 resections may underline the need for further centralization of gastric cancer care in the Netherlands. Electronic supplementary material The online version of this article (10.1245/s10434-019-07381-0) contains supplementary material, which is available to authorized users.

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confidence: 62%

Population-Based Study on Risk Factors for Tumor-Positive Resection Margins in Patients with Gastric Cancer

et al. 2019

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“…The results of the DUCA were compared with the results of the Swedish NREV (Nationellt Kvalitetsregister matstrups-och magsäckscancer). 20 However, the results of the registries at that time were not standardized, which makes comparison not really reliable.…”

Section: Discussionmentioning

confidence: 99%

Reporting National Outcomes After Esophagectomy and Gastrectomy According to the Esophageal Complications Consensus Group (ECCG)

et al. 2019

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Objective: This nationwide population-based study aimed to report postoperative morbidity and mortality after esophagectomy and gastrectomy in the Netherlands according to the definitions of the Esophagectomy Complications Consensus Group (ECCG). Background: To standardize international outcome reporting in esophageal surgery, the ECCG developed a standardized outcomes set. Methods: For this national cohort study, all patients undergoing esophagectomy or gastrectomy for cancer between 2016 and 2017 were selected from the Dutch Upper gastrointestinal Cancer Audit. In a random sample of hospitals, data completeness and accuracy were validated by reabstraction of the data. The investigated outcomes in the present study were postoperative complications, major complications (Clavien-Dindo grade !III), and 30-day mortality, according to definitions of the ECCG. Results: A total of 2545 patients from 22 hospitals were included. The completeness of the Dutch Upper gastrointestinal Cancer Audit was estimated at 99.8%. Data accuracy on different items was 94% to 100%. After esophagectomy, 1046 of 1617 patients (65%) had a postoperative complication including 468 patients (29%) with a major complication. Most common complications were pneumonia (21%), esophago-enteric leak from anastomosis, staple line or localized conduit necrosis (19%), and atrial dysrhythmia (15%). The 30-day mortality was 1.7%. After gastrectomy, 397 of 928 patients (42%) had a postoperative complication including 180 patients (19%) with a major complication. Most common complications were pneumonia (12%), esophago-enteric leak from anastomosis, staple line or localized conduit necrosis (9%), and acute delirium (5%). The 30-day mortality was 4.4%. Conclusions: Reporting complications according to the ECCG platform is feasible in the Netherlands and facilitates international benchmarking.

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“…We observed a steadily growing proportion of Swedish patients receiving preoperative oncological treatment, albeit to a lesser extent than in other countries. 3 Both 30- and 90-day mortality rates for resections of esophageal/GEJ cancer remain unchanged, whereas a decline in the corresponding figures for gastric cancer was seen. This could, in part, be explained by the process of centralization of these complex procedures in Sweden during this period, most notably accentuated for by gastric cancer.…”

Section: Discussionmentioning

confidence: 98%

“…Assuming high validity of the data entered into the register, comprehensive comparisons can be conducted between regions within a country or between countries. 2 , 3 Resection rates for both esophageal and gastric cancer have decreased in Sweden during the years 2007–2016 ( Fig. 4 ).…”

Section: Discussionmentioning

confidence: 99%

Improvements in esophageal and gastric cancer care in Sweden-population-based results 2007–2016 from a national quality register

Jeremiasen

Linder

Hedberg

et al. 2019

Diseases of the Esophagus

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SUMMARY The Swedish National Register for Esophageal and Gastric cancer was launched in 2006 and contains data with adequate national coverage and of high internal validity on patients diagnosed with these tumors. The aim of this study was to describe the evolution of esophageal and gastric cancer care as reflected in a population-based clinical registry. The study population was 12,242 patients (6,926 with esophageal and gastroesophageal junction (GEJ) cancers and 5,316 with gastric cancers) diagnosed between 2007 and 2016. Treatment strategies, short- and long-term mortality, gender aspects, and centralization were investigated. Neoadjuvant oncological treatment became increasingly prevalent during the study period. Resection rates for both esophageal/GEJ and gastric cancers decreased from 29.4% to 26.0% (P = 0.022) and from 38.8% to 33.3% (P = 0.002), respectively. A marked reduction in the number of hospitals performing esophageal and gastric cancer surgery was noted. In gastric cancer patients, an improvement in 30-day mortality from 4.2% to 1.6% (P = 0.005) was evident. Overall 5-year survival after esophageal resection was 38.9%, being higher among women compared to men (47.5 vs. 36.6%; P < 0.001), whereas no gender difference was seen in gastric cancer. During the recent decade, the analyses based on the Swedish National Register for Esophageal and Gastric cancer database demonstrated significant improvements in several important quality indicators of care for patients with esophagogastric cancers. The Swedish National Register for Esophageal and Gastric cancer offers an instrument not only for the control and endorsement of quality of care but also a unique tool for population-based clinical research.

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International benchmarking in oesophageal and gastric cancer surgery

Cited by 29 publications

References 36 publications

Population-Based Study on Risk Factors for Tumor-Positive Resection Margins in Patients with Gastric Cancer

Population-Based Study on Risk Factors for Tumor-Positive Resection Margins in Patients with Gastric Cancer

Reporting National Outcomes After Esophagectomy and Gastrectomy According to the Esophageal Complications Consensus Group (ECCG)

Improvements in esophageal and gastric cancer care in Sweden-population-based results 2007–2016 from a national quality register

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