scholarly journals Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure

2021 ◽  
Author(s):  
Marianne C Kalff ◽  
Mark I van Berge Henegouwen ◽  
Suzanne S Gisbertz
Keyword(s):  
Esophageal Cancer ◽  
Cancer Surgery ◽  
Quality Measure ◽  
Resection Margins ◽  
International Consensus ◽  
Term Survival ◽  
Intraoperative Complication ◽  
Esophageal Cancer Surgery ◽  
Perioperative Course

Summary Textbook outcome for esophageal cancer surgery is a composite quality measure including 10 short-term surgical outcomes reflecting an uneventful perioperative course. Achieved textbook outcome is associated with improved long-term survival. This study aimed to update the original textbook outcome based on international consensus. Forty-five international expert esophageal cancer surgeons received a personal invitation to evaluate the 10 items in the original textbook outcome for esophageal cancer surgery and to rate 18 additional items divided over seven subcategories for their importance in the updated textbook outcome. Items were included in the updated textbook outcome if ≥80% of the respondents agreed on inclusion. In case multiple items within one subcategory reached ≥80% agreement, only the most inclusive item with the highest agreement rate was included. With a response rate of 80%, 36 expert esophageal cancer surgeons, from 34 hospitals, 16 countries, and 4 continents responded to this international survey. Based on the inclusion criteria, the updated quality indicator ‘textbook outcome for esophageal cancer surgery’ should consist of: tumor-negative resection margins, ≥20 lymph nodes retrieved and examined, no intraoperative complication, no complications Clavien–Dindo ≥III, no ICU/MCU readmission, no readmission related to the surgical procedure, no anastomotic leakage, no hospital stay ≥14 days, and no in-hospital mortality. This study resulted in an international consensus-based update of a quality measure, textbook outcome for esophageal cancer surgery. This updated textbook outcome should be implemented in quality assurance programs for centers performing esophageal cancer surgery, and could standardize quality measures used internationally.

Prediction Model of Long-term Survival After Esophageal Cancer Surgery

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Shao-Hua Xie ◽  
Giola Santoni ◽  
Kalle Mälberg ◽  
Pernilla Lagergren ◽  
Jesper Lagergren
Keyword(s):  
Esophageal Cancer ◽  
Prediction Model ◽  
Cancer Surgery ◽  
Term Survival ◽  
Long Term Survival ◽  
Esophageal Cancer Surgery

Current Results of Esophageal Cancer Surgery. Time Trends in Operative Mortality and Long Term Survival

1987 ◽  
Vol 73 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Ugo Pastorino ◽  
Maurizio Valente ◽  
Marco Alloisio ◽  
Vittorio Bedini ◽  
Ignazio Cataldo ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Median Survival ◽  
Operative Mortality ◽  
Chinese Literature ◽  
Cancer Surgery ◽  
Perioperative Mortality ◽  
Term Survival ◽  
Long Term Survival ◽  
Esophageal Cancer Surgery

This paper represents a historical analysis of the results achieved by esophageal cancer surgery over the last three decades, as they appear in the literature of the years 1954–1985, and in our own experience between 1965 and 1985, with the aim of assessing the evolution of operative mortality and long-term survival. In a review of 4930 resections reported in western literature, mean values of perioperative mortality went down from 30 % to 9 %, while the five-year survival increased from 8 % to 19 %. Similar changes were evident in Japanese and Chinese literature where the survival rose from 9 % to 23 % in unscreened populations and up to 90 % in early cancers. In our experience, dividing the series in two decades (1965–74 and 1975–85), the overall perioperative mortality changed from 28 % to 13 %. The actuarial survival for the two periods was 8 % vs 18 % at 5 years, with a median survival of 9 and 18 months. A greater difference was evident for NO patients where the survival rose from 15 % to 35 % at 5 years, with a median survival of 15 vs 38 months.

705 SIGNIFICANCE OF CLEAR CIRCUMFERENTIAL RESECTION MARGIN IN ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Catherine Cheang ◽  
Pradeep Patil
Keyword(s):  
Esophageal Cancer ◽  
Multimodal Therapy ◽  
Resection Margin ◽  
Locally Advanced ◽  
Radical Resection ◽  
Resection Margins ◽  
R0 Resection ◽  
Term Survival ◽  
R1 Resection

Abstract   Circumferential resection margins (CRM) of an esophagectomy specimen for oesophageal cancer is a key prognostic factor of overall survival (OS). This retrospective study aims to compare OS of post-esophagectomy patients with CRM of >1 mm (R0) and < 1 mm (R1) with further subgroup analysis of locally advanced T3R0 vs T3R1 resection. Methods A total of 110 esophagectomies conducted between 2010 and 2020 were analysed. We recorded R stage based on pathological CRM >1 mm (R0) or < 1 mm (R1). OS was calculated from the day of surgery to day of death or otherwise censored. All patients underwent multimodal therapy including chemotherapy and similar pre-surgical and post-surgical management. 58 of these patients with pT3 stage esophageal cancer (EC) were selected and compared. Statistical analysis was carried out using SPSS. Results Of 110 patients, 78 (71.5%) patients had a R0 resection. Mean OS in R0 resections was 73 months (6 years) compared to 25.2 months (2 years) in R1 resection (p = 0.001). 58 of the 110 patients were pathological stage T3(pT3) despite downstaging with chemotherapy showing the burden of advanced disease. In patients with stage pT3 (n = 58), 32 patients were R0 resections, and 26 patients had R1 resections. Mean OS in T3R0 resections was 51.5 months compared to 28.5 months in T3R1 resection. OS comparison is significant (p = 0.011). Conclusion This study emphasizes the importance of clear CRM in all patients and especially in locally advanced pT3/T4a esophageal cancer in achieving long term survival. Techniques used to ensure a clear CRM such multimodality therapy combined with surgical radical resection concepts such as mesoesophagectomy should be employed.

scholarly journals Long-Term Oncologic Outcomes, Opioid Use, and Complications after Esophageal Cancer Surgery

2018 ◽  
Vol 7 (2) ◽  
pp. 33 ◽  
Author(s):  
Tak Kyu Oh ◽  
Kwhanmien Kim ◽  
Sang Hoon Jheon ◽  
Sang-Hwan Do ◽  
Jung-Won Hwang ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Surgery ◽  
Oncologic Outcomes ◽  
Opioid Use ◽  
Esophageal Cancer Surgery

Esophageal Cancer Surgery in Patients Older than 75: Long Term Results

2011 ◽  
Vol 111 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Ch. Honoré ◽  
A. Al-Azzeh ◽  
N. Gilson ◽  
D. Van Daele ◽  
M. Polua ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Surgery ◽  
Long Term Results ◽  
Esophageal Cancer Surgery

C-reactive protein at 4 days after surgery as an early predictor of serious infectious complications following esophageal cancer surgery.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 10-10
Author(s):  
Kazuki Kano ◽  
Takashi Ogata ◽  
Yukio Maezawa ◽  
Kenki Segami ◽  
Tetsushi Nakajima ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Diagnostic Accuracy ◽  
Odds Ratio ◽  
Infectious Complications ◽  
Cancer Surgery ◽  
Multivariate Logistic Regression Model ◽  
C Reactive Protein ◽  
Term Survival ◽  
Reactive Protein ◽  
Esophageal Cancer Surgery

10 Background: Serious infectious complications (SICs), frequently observed morbidities, have been reported to be related not only with short-term mortality but also with poor long-term survival in various types of malignancies including esophageal cancer. SICs usually develop 7 to 10 days after esophagectomy and early diagnosis is believed to be difficult because systemic response by SICs is considered to be covered by surgical invasion. The aim of this study was to investigate whether serum C-reactive protein (CRP) on postoperative day (POD) 4 can be predictor of SICs after esophageal cancer surgery. Methods: The present study retrospectively examined 110 consecutive patients undergoing open thoracic esophagectomy after neoadjuvant chemotherapy for thoracic esophageal cancer between January 2011 and June 2015. All patients received perioperative care of enhanced recovery after surgery program with steroid therapy. SICs were defined as morbidity of grade III or more according to the Clavien-Dindo classification. Diagnostic accuracy was determined by measuring the area under the receiver operating characteristic curve (AUC). Clinical and laboratory parameters including CRP, all available before or within POD 4, were analyzed with univariate and multivariate logistic regression model to identify SICs. Results: Median age was 68 years. SICs were observed in 20 patients (18.2%). CRP on POD 4 had superior diagnostic accuracy for PICs (AUC 0.759; 95% confidence interval [CI], 0.652-0.866). Cut-off value for CRP was determined as 4.0 mg/dl which yielded a sensitivity of 70.0%, a specificity of 74.4% and a negative predictive value of 91.8% for the detection of SICs. Multivariate analysis identified CRP ≥ 4.0 mg/dl on POD 4 (odds ratio of 8.399 with 95% CI, 2.646–26.666) and three-field lymph node dissection (odds ratio of 4.658 with 95% CI, 1.306–16.619) as predictive factors for SICs after esophagectomy. Conclusions: CRP on POD 4 was an early indicator for serious infectious complications after esophageal cancer surgery, which could encourage imaging study to detect the focus or early intervention by antibiotics.

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