Surgical workload and outcome after resection for carcinoma of the oesophagus and cardia

Gillison, E. W.; Powell, Jean; McConkey, Chris; Spychal, Robert

doi:10.1046/j.0007-1323.2001.02015.x

Cited by 109 publications

(90 citation statements)

References 8 publications

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“…7 However, the relationship between operative volume and mortality has not been universally confirmed. 9 It has also been suggested that moving complex surgery away from district general hospitals will de-skill staff from dealing with major emergencies. 7 In addition, many patients prefer to be treated in their local hospital.…”

Section: Table 2 Waiting Times To First Treatment January 2000 To Maymentioning

confidence: 99%

“…9 This study, covering a period before specific waiting target deadlines were applied to oesophagogastric cancer, shows that over 90% of patients were assessed within 2 weeks from the point of referral. This was achieved through the use of 'ring-fenced' clinic appointment slots, combining endoluminal ultrasound and clinic review in a single day and early contact and involvement with the clinical nurse specialist who also co-ordinated multidisciplinary team reviews.…”

mentioning

confidence: 99%

“…However, there has been little consensus regarding the possible benefits of either specialisation or operative volume on the outcomes of oesophagogastric cancer surgery in the UK. [5][6][7][8][9] The NHS Cancer Plan states that no patient with suspected cancer should wait longer than 2 months from an urgent referral by their general practitioner (GP) and no longer than 1 month from cancer diagnosis to the start of treatment. This has been applied to all cancers since 2001 and it is hoped that targets will be achieved by 2006.…”

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confidence: 99%

See 2 more Smart Citations

Centralisation of Oesophagogastric Cancer Services: Can Specialist Units Deliver?

Forshaw¹,

Gossage²,

Stephens³

et al. 2006

annals

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INTRODUCTION Oesophagogastric cancer surgery is increasingly being performed in only centralised units. The aim of the study was to examine surgical outcomes and service delivery within a specialist unit.PATIENTS AND METHODS The case notes of all patients undergoing attempted oesophagogastrectomy between January 2000 and May 2003 were identified from a prospective consultant database. RESULTS A total of 187 patients (median age, 63 years; range, 29-83 years; M:F ratio, 3.9:1) underwent attempted oesophagogastrectomy. Of these, 91% were seen within 2 weeks of referral and treatment was instituted after a mean of 31 days (range, 1-109 days). More patients underwent surgery (63%) than neoadjuvant therapy (56%) within 1 month of referral. The main indication for surgery was invasive malignancy in 166 patients (89%). The 30-day mortality was 0.5% (1 death) and in-hospital mortality was 1.1% (2 deaths). The median length of hospital stay was 14 days (range, 7-69 days). Significant postoperative morbidity included: pulmonary complications (36%), cardiovascular complications (16%), wound infection (13%) and clinically significant anastomotic leaks (7%). Of the study group, 28 patients (15%) were admitted to ICU with a median stay of 10 days (range, 1-44 days); this accounted for 0.9% of ICU bed availability. Twelve patients (6.4%) were returned to theatre, most commonly for bleeding. The 1-year survival rates were 78%. During 2002-2003, national waiting list targets for both hernia repair and cholecystectomy were achieved.CONCLUSIONS Despite recent increases in workload, high volume specialist units can deliver an efficient and timely service with both good treatment outcomes and minimal impact upon elective surgical waiting lists and ICU provision.

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Section: Table 2 Waiting Times To First Treatment January 2000 To Maymentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Centralisation of Oesophagogastric Cancer Services: Can Specialist Units Deliver?

Forshaw¹,

Gossage²,

Stephens³

et al. 2006

annals

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“…Oesophagectomies carry one of the highest postoperative mortality among elective surgical procedures with a 30-day mortality of around 7% (O'Connell et al, 2004). Unfortunately surgery in itself is not very effective, with 50% of stage I patients and 80% of stage II patients dying within 5 years and an overall cure rate from the small fraction of operable patients being only around 20% (Gilbert et al, 2002;Gillison et al, 2002).…”

mentioning

confidence: 99%

Do delays between diagnosis and surgery in resectable oesophageal cancer affect survival? a study based on West Midlands cancer registration data

2006

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This retrospective study investigates if delays between the diagnosis of cancer of the oesophagus and surgical resection influence long-term survival. Data held by the West Midlands Cancer Intelligence Unit on 800 patients who underwent oesophagectomy for a diagnosis of cancer of the oesophagus or oesophagogastric junction between 1995 and 2000 were reviewed. Six hundred and thirtytwo patients treated with curative intention and who had not received neo-adjuvant treatment in the form of radio-or chemotherapy were included in the analysis. The time interval between histological diagnosis and surgical resection was stratified into four groups: less than 3, 3 -6, 6 -9 and more than 9 weeks. The Cox proportional hazard model was used to test for the independent effect of delays. The results showed no difference in long-term survival according to the delay between histological diagnosis and surgical resection. On multivariate analysis adverse prognostic factors were advanced age, incomplete resection and lymph node involvement. Patients with a longer delay had a higher rate of complete tumour resection suggesting that they were more appropriately selected for the surgical treatment approach. In conclusion we have found no evidence that shorter delays from the date of histological diagnosis to surgical resection are beneficial to long-term survival.

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“…A number of potentially curative and palliative treatments exist and although surgical resection has remained the main chance of cure for this condition, treatment has latterly been reinforced by adjuvant chemoradiotherapy [9][10][11][12] and most recently with evidence of survival benefit from perioperative chemotherapy [13]. There is now evidence that a high surgical workload improves operative mortality but this is as much a factor of the hospital volume as of the surgeon [14][15][16] and in the UK this has lead to regionalization of high risk gastrointestinal surgery.…”

Section: Esophageal Carcinoma In 1985 Was the Ninth Most Common Maligmentioning

confidence: 99%

The Changing Management of Esophageal Carcinoma: Survival in a Population Cohort 1985-1994

Bates¹,

Antoniou²,

Marshall³

et al. 2008

TOCCJ

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Abstract:Background: The management of esophageal carcinoma is changing but before the introduction of chemotherapy and multidisciplinary teams, surgery became more selective. The aim of this study was to confirm this trend and to examine survival in a total population cohort 1985-94.Results: Only a quarter of 413 patients had surgery but from 1989 even fewer were operated on but there were more longterm survivors: 1/51 v. 7/58 (p<0.05). Operative mortality fell from 12% to 6.9 % in the later period (N.S.) and survival post surgery was marginally improved, 15 v. 11 months p = 0.0502. The five year survival rate doubled from 7.8% to 17.2%. Conclusion:Few studies of esophageal cancer include all cases in a defined population. This carries a very poor prognosis but the present cohort shows a slight improvement with more selective surgery and this may serve as a benchmark against which modern multidisciplinary management might be compared.

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Surgical workload and outcome after resection for carcinoma of the oesophagus and cardia

Abstract: In this unselected population-based series there was little evidence of a trend of improving 30-day mortality rate with increasing workload, or between workload and long-term survival.

Cited by 109 publications

References 8 publications

Centralisation of Oesophagogastric Cancer Services: Can Specialist Units Deliver?

Centralisation of Oesophagogastric Cancer Services: Can Specialist Units Deliver?

Do delays between diagnosis and surgery in resectable oesophageal cancer affect survival? a study based on West Midlands cancer registration data

The Changing Management of Esophageal Carcinoma: Survival in a Population Cohort 1985-1994

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