Modern oncological and operative outcomes in oesophageal cancer: the St. James’s hospital experience

Donlon, Noel E; Ravi, Narayanasamy; King, Sinéad; Cunninhgam, Moya; Cuffe, Sinéad; Lowery, Maeve A.; Wall, Carmel; Hughes, Niall; Muldoon, Cian; Ryan, Ciara; Moore, Jenny; O'Farrell, Catherine; Gorry, Claire; Duff, Ann-Marie; Enright, Cathy; Nugent, Tim; Elliot, Jessie A; Donohoe, Claire L.; Reynolds, John V.

doi:10.1007/s11845-020-02321-4

Cited by 10 publications

(9 citation statements)

References 30 publications

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“…Patients in the Irish population with oesophageal cancer tend to be older and have medical comorbidities, with a high incidence of cardiorespiratory disease, obesity, and diabetes [9]. When this is combined with complex major surgery with an inherent significant risk of perioperative cardio-pulmonary complications, and a risk of mortality of between 1 and 5%, the added risk of mortality would be high if they acquired COVID-19 in the perioperative period.…”

Section: Introductionmentioning

confidence: 99%

Successful maintenance of process and outcomes for oesophageal cancer surgery in Ireland during the first wave of the COVID-19 pandemic

et al. 2021

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Introduction The emergence of the novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the coronavirus disease COVID-19 has impacted enormously on non-COVID-19-related hospital care. Curtailment of intensive care unit (ICU) access threatens complex surgery, particularly impacting on outcomes for time-sensitive cancer surgery. Oesophageal cancer surgery is a good example. This study explored the impact of the pandemic on process and shortterm surgical outcomes, comparing the first wave of the pandemic from April to June in 2020 with the same period in 2019. Methods Data from all four Irish oesophageal cancer centres were reviewed. All patients undergoing resection for oesophageal malignancy from 1 April to 30 June inclusive in 2020 and 2019 were included. Patient, disease, and peri-operative outcomes (including COVID-19 infection) were compared. Results In 2020, 45 patients underwent oesophagectomy, and 53 in the equivalent period in 2019. There were no differences in patient demographics, co-morbidities, or use of neoadjuvant therapy. The median time to surgery from neoadjuvant therapy was 8 weeks in both 2020 and 2019. There were no significant differences in operative interventions between the two time periods. There was no difference in operative morbidity in 2020 and 2019 (28% vs 40%, p = 0.28). There was no in-hospital mortality in either period. No patient contracted COVID-19 in the perioperative period. Conclusions Continuing surgical resection for oesophageal cancer was feasible and safe during the COVID-19 pandemic in Ireland. The national response to this threat was therefore successful by these criteria in the curative management of oesophageal cancer.

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Section: Introductionmentioning

confidence: 99%

Successful maintenance of process and outcomes for oesophageal cancer surgery in Ireland during the first wave of the COVID-19 pandemic

et al. 2021

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“…Recent reports indicate an approximate 5-year survival of between 15 and 25% [ 1 – 3 ]. However, 5-year survival has increased to approximately 50% amongst those who can be treated with curative intent [ 4 ]. Consequently, there is an emerging focus on enhanced recovery after surgery (ERAS) pathways to optimize clinical and health related quality of life outcomes amongst survivors (QOL) [ 5 , 6 ].…”

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confidence: 99%

Exercise-based dysphagia rehabilitation for adults with oesophageal cancer: a systematic review

et al. 2022

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Background Dysphagia is prevalent in oesophageal cancer with significant clinical and psychosocial complications. The purpose of this study was i) to examine the impact of exercise-based dysphagia rehabilitation on clinical and quality of life outcomes in this population and ii) to identify key rehabilitation components that may inform future research in this area. Methods Randomised control trials (RCT), non-RCTs, cohort studies and case series were included. 10 databases (CINAHL Complete, MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest Dissertations and Theses, OpenGrey, PROSPERO, RIAN and SpeechBITE), 3 clinical trial registries, and relevant conference abstracts were searched in November 2020. Two independent authors assessed articles for eligibility before completing data extraction, quality assessment using ROBINS-I and Downs and Black Checklist, followed by descriptive data analysis. The primary outcomes included oral intake, respiratory status and quality of life. All comparable outcomes were combined and discussed throughout the manuscript as primary and secondary outcomes. Results Three single centre non-randomised control studies involving 311 participants were included. A meta-analysis could not be completed due to study heterogeneity. SLT-led post-operative dysphagia intervention led to significantly earlier start to oral intake and reduced length of post-operative hospital stay. No studies found a reduction in aspiration pneumonia rates, and no studies included patient reported or quality of life outcomes. Of the reported secondary outcomes, swallow prehabilitation resulted in significantly improved swallow efficiency following oesophageal surgery compared to the control group, and rehabilitation following surgery resulted in significantly reduced vallecular and pyriform sinus residue. The three studies were found to have ‘serious’ to ‘critical’ risk of bias. Conclusions This systematic review highlights a low-volume of low-quality evidence to support exercise-based dysphagia rehabilitation in adults undergoing surgery for oesophageal cancer. As dysphagia is a common symptom impacting quality of life throughout survivorship, findings will guide future research to determine if swallowing rehabilitation should be included in enhanced recovery after surgery (ERAS) programmes. This review is limited by the inclusion of non-randomised control trials and the reliance on Japanese interpretation which may have resulted in bias. The reviewed studies were all of weak design with limited data reported.

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“… 3–7 Post-operative complications include pulmonary dysfunction, atrial fibrillation and anastomotic leak. 8 Post-operative pulmonary complications (PPCs) are among the most serious postoperative challenges occurring between 15% and 40% of patients post-oesophagectomy, impacting length of stay in critical care units, increasing overall hospital stay with significant cost implications. 9 10 Malnutrition, weight loss and sarcopaenia are common after surgery or combination therapies.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7] Post-operative complications include pulmonary dysfunction, atrial fibrillation and anastomotic leak. 8 Postoperative pulmonary complications (PPCs) are among the most serious postoperative challenges occurring between 15% and 40%…”

Section: Introductionmentioning

confidence: 99%

Prevalence, nature and trajectory of dysphagia postoesophageal cancer surgery: a prospective longitudinal study protocol

et al. 2022

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IntroductionDysphagia is a common problem following oesophagectomy, and is associated with aspiration pneumonia, malnutrition, weight loss, prolonged enteral feeding tube dependence, in addition to an extended in-hospital stay and compromised quality of life (QOL). To date, the prevalence, nature and trajectory of post-oesophagectomy dysphagia has not been systematically studied in a prospective longitudinal design. The study aims (1) to evaluate the prevalence, nature and trajectory of dysphagia for participants undergoing an oesophagectomy as part of curative treatment, (2) to determine the risk factors for, and post-operative complications of dysphagia in this population and (3) to examine the impact of oropharyngeal dysphagia on health-related QOL across time points.Methods and analysisA videofluoroscopy will be completed and analysed on both post-operative day (POD) 4 or 5 and at 6-months post-surgery. Other swallow evaluations will be completed preoperatively, POD 4 or 5, 1-month and 6-month time points will include a swallowing screening test, tongue pressure measurement, cough reflex testing and an oral hygiene evaluation. Nutritional measurements will include the Functional Oral Intake Scale to measure feeding tube reliance, Malnutrition Screening Tool and the Strength, Assistance With Walking, Rise From a Chair, Climb Stairs and Falls questionnaire. The Reflux Symptom Index will be administered to investigate aerodigestive symptoms commonly experienced by adults post-oesophagectomy. Swallowing-related QOL outcome measures will be determined using the European Organisation for Research and Treatment of Cancer QLQ-18, MD Anderson Dysphagia Inventory and the Swallowing Quality of Life Questionnaire.Ethics and disseminationEthical approval has been granted by the Tallaght University Hospital/St. James’ Hospital Research Ethics Committee (JREC), Dublin, Ireland (Ref. No. 2021-Jul-310). The study results will be published in peer-reviewed journals and presented at national and international scientific conferences.

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Modern oncological and operative outcomes in oesophageal cancer: the St. James’s hospital experience

Cited by 10 publications

References 30 publications

Successful maintenance of process and outcomes for oesophageal cancer surgery in Ireland during the first wave of the COVID-19 pandemic

Successful maintenance of process and outcomes for oesophageal cancer surgery in Ireland during the first wave of the COVID-19 pandemic

Exercise-based dysphagia rehabilitation for adults with oesophageal cancer: a systematic review

Prevalence, nature and trajectory of dysphagia postoesophageal cancer surgery: a prospective longitudinal study protocol

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