Skip to main content
SpringerLink
Log in

Short-Term Outcomes of Oesophagectomy in a Real-World Scenario from a Tier II City in India

  • Original Article
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

This study evaluates short-term outcomes of oesophagectomy at a low-volume cancer hospital in Visakhapatnam, India. Fifteen patients who underwent oesophagectomy from 2020 to 2023 were analysed. The most common histology was squamous cell carcinoma. The mean age was 55 years and the majority were male. The common approaches used were open transhiatal and transthoracic oesophagectomy. The mean operative time was 9.5 h, and the mean hospital stay was 15.92 days. There were no perioperative deaths, but complications included pulmonary issues, vocal cord paralysis, anastomotic leaks, chyle leaks and wound infections. Higher volume centres tend to have better outcomes after oesophagectomy. However, factors other than volume like patient selection, ERAS (Enhanced Recovery After Surgery) protocols, specialized critical care and trained multidisciplinary teams also impact outcomes. At our centre, though a low-volume hospital, proper patient selection, prehabilitation and a collaborative team approach helped achieve acceptable results. We recommend developing consensus on defining low- and high-volume centres for oesophagectomy in the Indian context, based on disease burden, resources and constraints. Overall, there is a lack of Indian data comparing outcomes between low and high-volume centres for oesophagectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Low DE, Alderson D, Cecconello I, Chang AC, Darling GE, DʼJourno XB, Griffin SM, Hölscher AH, Hofstetter WL, Jobe BA, Kitagawa Y, Kucharczuk JC, Law SY, Lerut TE, Maynard N, Pera M, Peters JH, Pramesh CS, Reynolds JV, Smithers BM, van Lanschot JJ. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg. 2015 262(2):286–94

  2. Metzger R, Bollschweiler E, Vallböhmer D, Maish M, DeMeester TR, Hölscher AH (2004) High volume centers for esophagectomy: what is the number needed to achieve low postoperative mortality? Dis Esophagus 17(4):310–314

    Article  CAS  PubMed  Google Scholar 

  3. Wouters MWJM, Gooiker GA, van Sandick JW et al (2012) The volume-outcome relation in the surgical treatment of esophageal cancer: a systematic review and meta-analysis. Cancer 118:1754–1763

    Article  PubMed  Google Scholar 

  4. Reavis Kevin M et al (2008) Outcomes of esophagectomy at academic centers: an association between volume and outcome. American Surg 74:939–943

    Article  Google Scholar 

  5. Funk, Luke M. et al. (2011)“Esophagectomy outcomes at low-volume hospitals: the association between systems characteristics and mortality.” Ann Surg 253 912–917

  6. de Geus SW, Papageorge MV, Woods AP, Wilson S, Ng SC, Merrill A, Cassidy M, McAneny D, Tseng JF, Sachs TE (2022) A rising tide lifts all boats: impact of combined volume of complex cancer operations on surgical outcomes in a low-volume setting. J Am Coll Surg 234(6):981–988

    Article  PubMed  PubMed Central  Google Scholar 

  7. Smith BR, Hinojosa MW, Reavis KM, Nguyen NT (2008) Outcomes of esophagectomy according to surgeon’s training: general vs. thoracic. J Gastrointest Surg 12(11):1907–11

    Article  PubMed  Google Scholar 

  8. Veelo DP, Geerts BF (2017) Anaesthesia during oesophagectomy. J Thorac Dis 9(Suppl 8):S705–S712

    Article  PubMed  PubMed Central  Google Scholar 

  9. de Manzoni G, Di Leo A (2012) Esophageal cancer surgery: the importance of hospital volume. In: de Manzoni G (ed) Treatment of Esophageal and Hypopharyngeal Squamous Cell Carcinoma. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-2330-7_9

    Chapter  Google Scholar 

  10. Low Donald E et al (2018) Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS®) society recommendations. World J. Surg 43:299–330

    Article  Google Scholar 

  11. Christian CK, Gustafson ML, Betensky RA et al (2003) The Leapfrog volume criteria may fall short in identifying high-quality surgical centers. Ann Surg 238:447–455

    Article  PubMed  PubMed Central  Google Scholar 

  12. Clark JM, Cooke DT, Hashimi H, Chin D, Utter GH, Brown LM, Nuño M (2021) Do the 2018 Leapfrog Group minimal hospital and surgeon volume thresholds for esophagectomy favor specific patient demographics? Ann Surg 274(3):e220–e229

    Article  PubMed  Google Scholar 

  13. Meguid RA, Weiss ES, Chang DC, Brock MV, Yang SC (2009) The effect of volume on esophageal cancer resections: what constitutes acceptable resection volumes for centers of excellence? J Thorac Cardiovasc Surg 137(1):23–29

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kato H, Tachimori Y, Watanabe H et al (1997) Thoracic esophageal carcinoma above the carina: a formidable adversary? J Surg Oncol 65:28–33

    Article  CAS  PubMed  Google Scholar 

  15. Nakamuva M, Iwahashi M, Nakamori M et al (2008) Analysis of factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer. Langenbecks Arch Surg 393:127–133

    Article  Google Scholar 

  16. Orringer MB, Marshall B, Iannettoni MD. (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg. 230(3):392–400; discussion 400–3

  17. Hulscher JB, Tijssen JG, Obertop H, van Lanschot JJ (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg 72(1):306–313

    Article  CAS  PubMed  Google Scholar 

  18. Rindani R, Martin CJ, Cox MR (1999) Transhiatal versus Ivor-Lewis oesophagectomy: is there a difference? Aust N Z J Surg 69(3):187–194

    Article  CAS  PubMed  Google Scholar 

  19. Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL. (2007) Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg. 246(3):363–72; discussion 372–4

  20. Vrba R, Aujesky R, Hrabalova M, Vomackova K, Cincibuch J, Neoral C (2012) Esophagectomy for esophageal carcinoma–surgical complications and treatment. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 156(3):278–283

    Article  PubMed  Google Scholar 

  21. Das, G. (2022). 296. A beginner’s three-year learning curve with esophagectomies: a study from a peripheral cancer centre in North-east India. Diseases of the Esophagus

  22. Sharma S (2013) Management of complications of radical esophagectomy. Indian J Surg Oncol 4:105–111

    Article  PubMed  PubMed Central  Google Scholar 

  23. Khoushhal Z, Canner J, Schneider E, Stem M, Haut E, Mungo B, Lidor A, Molena D (2016) Influence of specialty training and trainee involvement on perioperative outcomes of esophagectomy. Ann Thorac Surg. 102(6):1829–1836. https://doi.org/10.1016/j.athoracsur.2016.06.025

    Article  PubMed  Google Scholar 

  24. Law S-K (2010) Esophagectomy without mortality: what can surgeons do? J Gastrointest Surg 14:101–107

    Article  Google Scholar 

  25. Reeh M, Metze J, Uzunoglu FG, Nentwich M, Ghadban T, Wellner U, Bockhorn M, Kluge S, Izbicki JR, Vashist YK (2016) The PER (Preoperative Esophagectomy Risk) score: a simple risk score to predict short-term and long-term outcome in patients with surgically treated esophageal cancer. Medicine (Baltimore) 95(7):e2724. https://doi.org/10.1097/MD.0000000000002724

    Article  PubMed  PubMed Central  Google Scholar 

  26. Xi Yong et al (2020) An esophagectomy surgical Apgar score (eSAS)-based nomogram for predicting major morbidity in patients with esophageal carcinoma. Transl Cancer Res 9:1732–1741

    Article  PubMed  PubMed Central  Google Scholar 

  27. Milstein A, Galvin RS, Delbanco SF et al (2000) Improving the safety of health care: the Leapfrog initiative. Eff Clin Pract 3:313–316

    CAS  PubMed  Google Scholar 

  28. Fuchs HF, Harnsberger CR, Broderick RC, Chang DC, Sandler BJ, Jacobsen GR et al (2017) Mortality after esophagectomy is heavily impacted by center volume: retrospective analysis of the nationwide inpatient sample. Surg Endosc 31:2491–2497

    Article  PubMed  Google Scholar 

  29. Dolan D, White A, Lee DN, Mazzola E, Polhemus E, Kucukak S, Wee JO, Swanson SJ. (2022) Short and long-term outcomes among high-volume vs low-volume esophagectomy surgeons at a high-volume center. Semin Thorac Cardiovasc Surg. Winter 34(4):1340–1350

  30. van Lanschot JJ, Hulscher JB, Buskens CJ, Tilanus HW, ten Kate FJ, Obertop H (2001) Hospital volume and hospital mortality for esophagectomy. Cancer 91(8):1574–1578

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Homi Bhabha Cancer Hospital & Research Centre, Visakhapatnam, 530053, Andhra Pradesh, India

    Amita Sekhar Padhy, Rigved Nittala, Srikarthik Voleti & Chaitanya Raju Chalapaka

Authors
  1. Amita Sekhar Padhy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rigved Nittala
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Srikarthik Voleti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chaitanya Raju Chalapaka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rigved Nittala.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Objective

To evaluate short-term outcomes of oesophagectomy from a low-volume and resource-constrained centre in a Tier II city in India.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Padhy, A.S., Nittala, R., Voleti, S. et al. Short-Term Outcomes of Oesophagectomy in a Real-World Scenario from a Tier II City in India. Indian J Surg Oncol (2024). https://doi.org/10.1007/s13193-024-01924-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13193-024-01924-y

Keywords

Search

Navigation