Evaluation of International Contemporary Operative Outcomes and Management Trends Associated With Esophagectomy: A 4-Year Study of >6000 Patients Using ECCG Definitions and the Online Esodata Database

Madhan K. Kuppusamy, Donald E. Low, International Esodata Study Group (IESG), Sjoerd Lagarde

Research output: Contribution to journalArticleAcademicpeer-review

22 Citations (Scopus)

Abstract

OBJECTIVE: This study aims to verify the utility of international online datasets to benchmark and monitor treatment and outcomes in major oncologic procedures. BACKGROUND: The Esophageal Complication Consensus Group (ECCG) has standardized the reporting of complications after esophagectomy within the web-based Esodata.org database. This study will utilize the Esodata dataset to update contemporary outcomes and to monitor trends in practice in an era of rapid technical change. METHODS: This observational study, based on a prospectively developed specific database, updates esophagectomy outcomes collected between 2015 and 2018. Evolution in patient and operative demographics, treatment, complications, and quality outcome measures were compared between patients undergoing surgery in 2015 to 2016 and 2017 to 2018. RESULTS: Between 2015 and 2018, 6022 esophagectomies from 39 centers were entered into Esodata. Most patients were male (78.3%) with median age 63. Patients having minimally invasive esophagectomy constituted 3177 (52.8%), a chest anastomosis 3838 (63.7%), neoadjuvant chemoradiotherapy 2834 (48.7%), and R0 resections 5441 (93.5%). For quality measures, 30- and 90-day mortality was 2.0% and 4.5%, readmissions 9.7%, transfusions 12%, escalation in care 22.1%, and discharge home 89.4%. Trends in quality measures between 2015 and 2016 (2407 patients) and 2017 and 2018 (3318 patients) demonstrated significant (P < 0.05) improvements in readmissions 11.1% to 8.5%, blood transfusions 14.3% to 10.2%, and escalation in care from 24.5% to 20% A significantly (P < 0.05) reduced incidence in pneumonia (15.3%-12.8%) and renal failure (1.0%-0.4%) was observed. Anastomotic leak rates increased from 11.7% to 13.1%, whereas leaks requiring surgery decreased 3.3% and 3.0%, respectively. CONCLUSIONS: The Esodata database provides a valuable resource for assessing contemporary international outcomes. This study highlights an increased application of minimally invasive approaches, a high percentage of complications, improvements in pneumonia and key quality metrics, but with anastomotic leak rates still >10%.

Original languageEnglish
Pages (from-to)515-525
Number of pages11
JournalAnnals of Surgery
Volume275
Issue number3
DOIs
Publication statusPublished - 1 Mar 2022

Bibliographical note

SPECIAL ACKNOWLEDGEMENTS:
All Members of the IESG wish to provide particular thanks to the Hayward Family Foundation, particularly Admiral Thomas Hayward, his wife Peggy Hayward, and two daughters Cynthia Hayward and Colleen Smith. The creation and maintenance of the Esodata.org database would not have been possible without their assistance.

Special acknowledgement should also be made to Ms. Bonnie Marston for administrative and manuscript support, and to Dr. Fredrik Klevebro and Dr. Francesco Puccetti for their invaluable assistance in data management and statistical review.

Publisher Copyright:
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

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