191 CURRENT STATUS OF ESOPHAGECTOMY IN JAPANESE NATIONAL CLINICAL DATABASE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Yoshihiro Kakeji ◽  
Arata Takahashi ◽  
Hiroshi Hasegawa ◽  
Gosuke Takiguchi ◽  
Taro Oshikiri ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Endoscopic Surgery ◽  
Current Status ◽  
Risk Calculator ◽  
Clinical Database ◽  
National Clinical Database ◽  
Data Registration ◽  
Certification System ◽  
Grade Iii

Abstract   The Japanese National Clinical Database (NCD) started its data registration since 2011, has grown up to a large nationwide database covering more than 95% of the surgeries performed by regular surgeons in Japan. The NCD grew rapidly harvesting over 11 million cases data between 2011 and 2018 from more than 5,000 facilities. Methods In this period, the surgeries of the esophagus were performed for 70,528 cases. In 2018, 93.8% of surgeries were performed at certified institutions, and 94.7% did with the participation of the board-certified surgeon. The board-certified surgeons operated 75.2% of the surgeries. Results Esophagectomy was performed for 47,055 patients in eight years. In 2018, 23.3% of the cases were 75 years old or more. Postoperative complications of Clavien Dindo classification grade III or higher occurred in 22.9% of all. As the patients have been getting older, the morbidities have been increasing. However, the mortalities have been kept at a low level. Postoperative 30-day and 90-day mortalities were 0.9% and 1.9%, respectively. The rates of endoscopic surgery have been increasing year by year, especially high in esophagectomy, which was 61.0% in 2018. Conclusion A risk-adjusted analysis based on nationwide data allows personnel to establish and provide feedback on the risks that patients face before undergoing a procedure. The risk calculator for eight main procedures are available on the websites of the hospitals that are a part of NCD. Nationwide this database is surely expecting to ensure the quality of board certification system and surgical outcomes in gastroenterological surgery.

scholarly journals Current status of surgery for clinical stage IA lung cancer in Japan: analysis of the national clinical database

Surgery Today ◽  
2020 ◽  
Vol 50 (12) ◽  
pp. 1644-1651
Author(s):  
Norihiko Ikeda ◽  
Shunsuke Endo ◽  
Eriko Fukuchi ◽  
Jun Nakajima ◽  
Kohei Yokoi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Wedge Resection ◽  
Clinical Stage ◽  
Postoperative Mortality ◽  
Current Status ◽  
Clinical Database ◽  
National Clinical Database ◽  
Invasive Approach ◽  
Clinical Stage Ia ◽  
Stage Ia

Abstract Purpose As the number of cases of early lung cancer in Japan grows, an analysis of the present status of surgical treatments for clinical stage IA lung cancer using a nationwide database with web-based data entry is warranted. Methods The operative and perioperative data from 47,921 patients who underwent surgery for clinical stage IA lung cancer in 2014 and 2015 were obtained from the National Clinical Database (NCD) of Japan. Clinicopathological characteristics, surgical procedure, mortality, and morbidity were analyzed, and thoracotomy and video-assisted thoracic surgery (VATS) were compared. Results The patients comprised 27,208 men (56.8%) and 20,713 women (43.2%); mean age, 69.3 years. Lobectomy was performed in 64.8%, segmentectomy in 15.2%, and wedge resection in 19.8%. The surgical procedures were thoracotomy in 12,194 patients (25.4%) and a minimally invasive approach (MIA) in 35,727 patients (74.6%). MIA was divided into VATS + mini-thoracotomy (n = 13,422, 28.0%) and complete VATS (n = 22,305, 46.5%). The overall postoperative mortality rate was 0.4%, being significantly lower in the MIA group than in the thoracotomy group (0.3% vs 0.8%, P < 0.001). Conclusions Our analysis of data from the NCD indicates that MIA has become the new standard treatment for clinical stage IA lung cancer.

scholarly journals Impact of certification status of the institute and surgeon on short-term outcomes after surgery for thoracic esophageal cancer: evaluation using data on 16,752 patients from the National Clinical Database in Japan

Esophagus ◽  
2019 ◽  
Vol 17 (1) ◽  
pp. 41-49 ◽  
Author(s):  
Satoru Motoyama ◽  
Hiroyuki Yamamoto ◽  
Hiroaki Miyata ◽  
Masahiko Yano ◽  
Takushi Yasuda ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Mortality Rates ◽  
Clinical Database ◽  
Short Term ◽  
National Clinical Database ◽  
Thoracic Esophageal Cancer ◽  
Certification System ◽  
Related Mortality

Abstract Background In 2009, the Japan Esophageal Society (JES) established a system for certification of qualified surgeons as “Board Certified Esophageal Surgeons” (BCESs) or institutes as “Authorized Institutes for Board Certified Esophageal Surgeons” (AIBCESs). We examined the short-term outcomes after esophagectomy, taking into consideration the certifications statuses of the institutes and surgeons. Methods This study investigated patients who underwent esophagectomy for thoracic esophageal cancer and who were registered in the Japanese National Clinical Database (NCD) between 2015 and 2017. Using hierarchical multivariable logistic regression analysis adjusted for patient-level risk factors, we determined whether the institute’s or surgeon’s certification status had greater influence on surgery-related mortality or postoperative complications. Results Enrolled were 16,752 patients operated on at 854 institutes by 1879 surgeons. There were significant differences in the backgrounds and incidences of postoperative complications and surgery-related mortality rates between the 11,162 patients treated at AIBCESs and the 5590 treated at Non–AIBCESs (surgery-related mortality rates: 1.6% vs 2.8%). There were also differences between the 6854 patients operated on by a BCES and the 9898 treated by a Non-BCES (1.7% vs 2.2%). Hierarchical logistic regression analysis revealed that surgery-related mortality was significantly lower among patients treated at AIBCESs. The institute’s certification had greater influence on short-term surgical outcomes than the operating surgeon’s certification. Conclusions The certification system for surgeons and institutes established by the JES appears to be appropriate, as indicated by the improved surgery-related mortality rate. It also appears that the JES certification system contributes to a more appropriate medical delivery system for thoracic esophageal cancer in Japan.

scholarly journals Can the Japanese National Clinical Database risk calculator predict long-term survival of patients who undergo palliative segmentectomy for primary lung cancer?

2021 ◽  
Author(s):  
Tomoyuki Nakano ◽  
Hiroyoshi Tsubochi ◽  
Mitsuru Maki ◽  
Kentaro Minegishi ◽  
Tomoki Shibano ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Thoracoscopic Surgery ◽  
Primary Lung Cancer ◽  
Risk Calculator ◽  
Clinical Database ◽  
National Clinical Database ◽  
Term Survival ◽  
Limited Surgery ◽  
Long Term Prognosis

Abstract Objectives Selection criteria for palliative limited surgery in patients with non-small cell lung cancer (NSCLC) can vary by institution or surgeon. We retrospectively reviewed outcomes of poor-risk patients who underwent palliative segmentectomy (PS), using the National Clinical Database Risk Calculator (RC). Methods We retrospectively analyzed medical records of patients with NSCLC tumors ≥ 20 mm and consolidation/tumor ratios ≥ 0.5 on computed tomography, who underwent PS from January 2009 to March 2016. Median follow-up time was 47 months (range 2–102 months). Results We enrolled 67 patients (median age: 73.0 years), of whom 54 received thoracoscopic surgery and 28 received medial lymph-node dissection. The RC’s mean predictive probability rate for perioperative mortality or severe complications was 7.1%. Of the 67 patients, 24 patients (43.0%) suffered post-surgical complications, including 2 (3%) who died in hospital; 17 eventually suffered NSCLC recurrences and/or metastases, 11 eventually died from NSCLC, and 17 died from other diseases. Five-year overall survival (OS) was 59.4%. When the patients were divided into high-risk (HR) and low-risk (LR) groups based on the RC, 5-year OS was significantly less in the HR group (43.9%) than in the LR group (82.2%; P < 0.05). Conclusion The RC, which was developed primarily to determine perioperative risk, can predict long-term prognosis for compromised patients who undergo PS.

scholarly journals Predicting and Preventing Postoperative Outcomes

2019 ◽  
Vol 32 (03) ◽  
pp. 149-156 ◽  
Author(s):  
Sung Lee ◽  
Andrew Russ
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Modifiable Risk Factors ◽  
Risk Calculator ◽  
Improvement Program ◽  
Mortality And Morbidity ◽  
Know How ◽  
Operative Severity Score ◽  
American College Of Surgeons

AbstractComplications after colorectal surgery are common. Given the frequency of postoperative complications and their implications on quality of life, it is important to know how to predict and prevent the complications that we encounter. This article aims to provide ways to predict and prevent postoperative complications in colorectal surgery. Here, we review the predictive models, American College of Surgeons National Surgery Quality Improvement Program risk calculator and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity on their practicality and usefulness. Additionally, this review summarizes nonmodifiable and modifiable risk factors in colorectal surgery, which are important for surgeons to understand to minimize and attempt to avoid postoperative complications as well as providing ways to optimize patients preoperatively. Thus, this review will provide information to surgeons to predict and prevent postoperative complications, how to optimize patients preoperatively and ultimately to help reduce their occurrence.

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