Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery

Gockel, Ines; Ahlbrand, Constantin J.; Arras, Michael; Schreiber, Elke; Lang, Hauke

doi:10.1007/s10620-015-3790-x

Cited by 11 publications

(6 citation statements)

References 74 publications

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“…This finding has also been reported in studies from other countries (6,7). Because the complexity of esophageal surgery means that they are associated with a host of perioperative risks, complications cannot always be avoided (20). However, the variation in survival of patients with complications shows that their management is an essential factor in explaining the volume-outcome association in complex esophageal surgery.…”

Section: Discussionsupporting

confidence: 78%

Hospital Volume, In-Hospital Mortality, and Failure to Rescue in Esophageal Surgery

Nimptsch¹,

Haist²,

Krautz³

et al. 2018

Deutsches Ärzteblatt International

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perations on the esophagus are highly complex interventions that place exacting demands both on the surgeon and on the whole team involved in pre-, peri-, and postoperative care. It has long been recognized that there is a strong association between the outcome of esophageal surgery and the volume of patients treated. Meta-analyses of studies from different countries have shown that the in-hospital mortality following esophageal interventions to treat malignant neoplasia is inversely related to the number of operations carried out at the institution concerned (1-3). A recently published German study confirmed this association and showed that in this country esophageal procedures often take place in hospitals with very low case volumes (4).

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Section: Discussionsupporting

confidence: 78%

Hospital Volume, In-Hospital Mortality, and Failure to Rescue in Esophageal Surgery

Nimptsch¹,

Haist²,

Krautz³

et al. 2018

Deutsches Ärzteblatt International

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“…Because of the vague [7–8 weeks] cutoff point used in the recent systematic review [7], we used alternative definitions [(1) 4–8 weeks vs 8–12 weeks; (2) 4–7 weeks vs 7–12 weeks] for the interval between nCCRT and esophagectomy to compare the OS as the first and second supplementary analyses (SA-1, SA-2) via separate PS matching. In the third SA (SA-3), we considered additional covariables [including site patient volume [21, 22] plus number of positive lymph node] and outcome [R0 resection], by constructing another PS-matched population for comparison. Although optimal interval was not specified in the recent treatment guideline [3], 4~6 weeks were commonly used in the RCT [23, 24].…”

Section: Methodsmentioning

confidence: 99%

Impact of the interval between neoadjuvant concurrent chemoradiotherapy and esophagectomy in the modern era: a population-based propensity-score-matched retrospective cohort study in Asia

et al. 2019

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BackgroundNeoadjuvant concurrent chemoradiotherapy (nCCRT) is one of the standard-of-care options for locally advanced esophageal squamous cell carcinoma (LA-ESqCC). The optimal interval between nCCRT and esophagectomy is unknown.MethodsWe constructed a propensity-score-matched [1:1 for long (8–12 weeks) vs short (4–7 weeks) intervals] cohort of LA-ESqCC patients who were diagnosed from 2011 to 2015 and treated with nCCRT via the Taiwan Cancer Registry and related databases. We compared the hazard ratios (HRs) of death using a robust variance estimator. We also evaluated alternative covariables, outcomes, and interval definitions.ResultsOur study population included 80 patients for each group; groups were balanced with respect to the observed covariables. There was no significant difference for the HR of death [1.22; 95% confidence interval 0.78–1.91, P = 0.39] when the long interval group was compared to the short interval group. There were also no significant differences when alternative covariables, outcomes, or interval definitions were evaluated.ConclusionsIn this population-based study in modern Asia, we found that for LA-ESqCC patients treated with nCCRT and esophagectomy, overall survival was similar for either long or short intervals between nCCRT and esophagectomy. Randomized controlled trials are needed to verify this finding.

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“…External beam radiotherapy delivery was classified as image-guided radiotherapy (IGRT) or non-IGRT. The hospital was classified as a high- or low-volume institute via a threshold [20 esophagectomies per year] [ 16 ]. The time period was classified as 2008–2009 or 2010–2015.…”

Section: Methodsmentioning

confidence: 99%

Neoadjuvant vs definitive concurrent chemoradiotherapy in locally advanced esophageal squamous cell carcinoma patients

Chen

Chien

2018

World J Surg Onc

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BackgroundThe optimal treatment for locally advanced esophageal squamous cell carcinoma remains unclear. We compared the clinical outcomes of neoadjuvant concurrent chemoradiotherapy (CCRT) followed by esophagectomy [the surgery group] and CCRT without surgery [the CCRT group] in patients with squamous cell carcinoma from an Asian population.MethodsEligible patients diagnosed from 2008 to 2015 were identified through the Taiwan Cancer Registry. To balance observable potential confounders, we constructed a 1:1 propensity score-matched cohort [surgery vs CCRT]. We compared the hazard ratios between the surgery and CCRT groups for death using a robust variance estimator. We also evaluated the outcomes of patients for freedom from local regional recurrence (FFLRR) and esophageal cancer-specific survival (ECSS). Extensive supplementary analyses were performed to examine the robustness of our findings.ResultsOur study population included 298 patients balanced with respect to the observed covariables. The hazard ratio of death was 0.56 [95% confidence interval 0.42~0.75] when surgery was compared to CCRT. The results remained significant in the FFLRR and ECSS outcomes. In the supplementary analyses, our results also remained significant when additional covariables were taken into consideration or when the definition of the index date was changed.ConclusionsWhen compared to definitive CCRT, neoadjuvant CCRT followed by esophagectomy was associated with improved overall survival for locally advanced esophageal squamous cell carcinoma. However, given the nonrandomized nature of the study and the sensitivity to potentially unmeasured confounders, our results should be interpreted cautiously.

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Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery

Cited by 11 publications

References 74 publications

Hospital Volume, In-Hospital Mortality, and Failure to Rescue in Esophageal Surgery

Hospital Volume, In-Hospital Mortality, and Failure to Rescue in Esophageal Surgery

Impact of the interval between neoadjuvant concurrent chemoradiotherapy and esophagectomy in the modern era: a population-based propensity-score-matched retrospective cohort study in Asia

Neoadjuvant vs definitive concurrent chemoradiotherapy in locally advanced esophageal squamous cell carcinoma patients

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