Surgical outcomes in gastroenterological surgery in Japan: Report of National Clinical database 2011–2016

Abstract

The National Clinical Database (NCD) of Japan started its registration in 2011 and over 9 000 000 cases from more than 5000 facilities were registered over a 6‐year period. This is the report of NCD based upon gastrointestinal surgery information in excess of 3 200 000 cases from 2011 to 2016 adding data of complications. About 70% of all gastrointestinal surgeries were carried out at certified institutions, and the percentage of surgeries done at certified institutions was particularly high for the esophagus (92.4% in 2016), liver (88.4%), pancreas (89.8%), and spleen (86.8%). The percentage of anesthesiologist participation was more than 90% for almost all organs, except 85.7% for the rectum and anus. Approximately, more than two‐thirds of the surgeries were carried out with the participation of a board‐certified surgeon. Although patients have been getting older, mortalities have not been increasing. There were differences in the incidence of complications according to organ site and procedure. Remarkably, mortality rates of low anterior resection were very low, and those of hepatectomy and acute diffuse peritonitis surgery have been gradually decreasing. Although the complication rates were gradually increasing for esophagectomy or pancreaticoduodenectomy, the mortality rates for these procedures were decreasing. Nationwide, this database is expected to ensure the quality of the board‐certification system and surgical outcomes in gastroenterological surgery.

Evaluation of Definitive Chemoradiotherapy Versus Radical Esophagectomy in Clinical T1bN0M0 Esophageal Squamous Cell Carcinoma

“…In addition, the progress of perioperative care is reported as another cause of reduced mortality [20][21][22]. Therefore, esophagectomy has become less invasive and the postoperative mortality rate at 90 days decreased from 3.2-1.9% from 2011 to 2018 [7]. In this study, surgery provided excellent OS, and this result con rmed the substantial status of radical esophagectomy as a standard treatment with clinical T1bN0M0 ESCC.…”

“…According to the 2017 esophageal cancer practice guidelines in Japan, promulgated by the Japan Esophageal Society, radical esophagectomy with regional lymph node (LN) dissection is a standard treatment for patients with clinical stage I, II, or III ESCC [5,6]. However, esophagectomy is a highly invasive procedure with a high risk of postoperative complications [7]. De nitive chemoradiotherapy (dCRT) is a treatment option when esophagectomy is contraindicated.…”

Perioperative and prognostic implication of albumin‐bilirubin‐TNM score in Child‐Pugh class A hepatocellular carcinoma

“…Currently, thanks to achievements made by our predecessors, the safety and feasibility of hepatectomy have been greatly improved. However, a report by the National Clinical Database group in Japan showed that the rate of mortality at hepatectomy and at 30 days postoperatively was still 2.3% and 1.3%, respectively, in 2016 . We believe that even among patients diagnosed with relatively well‐preserved hepatic function (CP class A), some might be better off undergoing non‐surgical treatment.…”

Risk model for severe postoperative complications after total pancreatectomy based on a nationwide clinical database

“…The procedure is performed to achieve complete tumour clearance of pancreatic neoplasms that are locally advanced or located in the centre of the pancreas, such as pancreatic cancer and intraductal papillary mucinous neoplasm. Rates of total pancreatectomy have gradually increased in Japan and globally. However, limited data are available for morbidity and mortality after total pancreatectomy.…”