Skip to main content
SpringerLink
Log in

Surgical Outcomes Associated with Oesophagectomy in New South Wales: An Investigation of Hospital Volume

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Resection remains the standard treatment for curable oesophageal cancer. By linking the NSW Central Cancer Registry (CCR) and the NSW Admitted Patient Data Collection (APDC) databases, mortality, post-resection complication and survival associated with oesophagectomy were investigated.

Methods

All patients diagnosed with oesophageal cancer from 2000 to 2005 as recorded in the CCR (n = 2,082) were linked with records in the APDC, giving a total of 17,205 episodes of care. Over 15% (n = 321) of all patients underwent an oesophagectomy.

Results and Discussion

The overall 30-day mortality rate following resection was 3.7%, ranging from 2.6% in high volume hospitals to 6.4% in low volume hospitals. Three-year absolute survival for localised-regional disease following oesophagectomy was 64% (95%CI 54–73%) in high-volume hospitals, 58% (95%CI 46–68%) in mid-volume and 45% (95%CI 23–65%) in low-volume hospitals. The post-resection complication rate was 19% (95%CI 13–26%) for high-volume hospital, 24% (95%CI 13–40%) in low-volume and 31% (95%CI 22–41%) in mid-volume hospitals.

Conclusion

Oesophagectomy in NSW is performed with satisfactory results. However, there is a suggestion that higher‐ rather than lower-volume hospitals have better post‐resection outcomes.

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. Tracey EA, Baker D, Chen W, Stavrou E, Bishop J. Cancer in New South Wales: Incidence, Mortality and Prevalence, 2005. Sydney; 2007.

  2. Stavrou EP, Baker D, McElroy H, Bishop J. Oesophageal Cancer in New South Wales. Sydney: Cancer Institute NSW; 2009.

  3. Crane SJ, Locke III GR, Harmesen WS, Diehl NN, Zinsmeister AR, Melton III LJ, et al. The changing incidence of oesophageal and gastric adenocarcinoma by anatomic sub-site. Aliment Pharmacol Ther 2007;25:447–453.

    Article  CAS  PubMed  Google Scholar 

  4. Lord RVN, Law MG, Ward RL, Giles GG, Thomas RJS, Thursfield V. Rising incidence of oesophageal adenocarcinoma in men in Australia. J Gastroenterol Hepatol 1998;13:356–362.

    Article  CAS  PubMed  Google Scholar 

  5. Pera M, Cameron AJ, Trastek VF, et al. Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction. Gastroenterology 1993;104:510.

    CAS  PubMed  Google Scholar 

  6. Stavrou EP, McElroy HJ, Baker DF, Bishop JF. Adenocarcinoma of the oesophagus: incidence and survival rates in New South Wales, 1972–2005. Med J Aust 2009;191:310–314.

    PubMed  Google Scholar 

  7. Tracey EA, Barraclough H, Chen W, Baker D, Roder D, Jelfs P, et al. Survival from Cancer in NSW: 1980 to 2003. Sydney: Cancer Institute NSW; 2007 Contract No.: Document Number|.

  8. Greene F, Page D, Fleming I, al. e. Esophageal tumors. In: Greene F, Page D, Fleming I, et al., eds. AJCC cancer staging manual. New York: Springer-Verlag; 2002.

    Chapter  Google Scholar 

  9. Gananadha S, Hazebroek EJ, Leibman S, et al. The utility of FDG-PET in the pre-operative staging of oesophageal cancer. Dis Esophagus 2008;21:389–394.

    Article  CAS  PubMed  Google Scholar 

  10. Swisher SG, Maish M, Erasmus JJ, et al. Utility of PET, CT and EUS to identify pathologic responders in esophageal cancer. Ann Thorac Surg 2004;78:1152–1160.

    Article  PubMed  Google Scholar 

  11. Bachmann MO, Alderson N, Edwards D, Wotton S, Bedford C, Peters TJ, et al. Cohort study in South and West England of the influence of specialization on the management and outcome of patients with oesophageal and gastric cancers. Br J Surg 2002;89:914–922.

    Article  CAS  PubMed  Google Scholar 

  12. Pye JK, Crumplin MKH, Charles J, Kerwat R, Foster ME, Biffin A. One-year survey of carcinoma of the oesophagus and stomach in Wales. Br J Surg 2001;88:278–285.

    Article  CAS  PubMed  Google Scholar 

  13. Swisher SG, Deford L, Merriman KW, Walsh GL, Smythe R, Vaporicyan A, et al. Effect of operative volume on morbidity, mortality and hospital use after esophagectomy for cancer. J Thorac Cardivasc Surg 2000;119:1126–1132.

    Article  CAS  Google Scholar 

  14. van Lanschot JJB, Hulscher JB, Buskens CJ, Tilanus HW, ten Kate FJW, Obertop H. Hospital volume and hospital mortality for esophagectomy. Cancer 2001;91:1574–1578.

    Article  PubMed  Google Scholar 

  15. Wouters MW, Wijnhoven BP, Karim-Kos HE, Blaauwgeers HG, Stassen LP, Steup W-H, et al. High-volume versus low-volume for esophageal resections for cancer: The essential role of case-mix adjustments based on clinical data. Ann Surg Oncol 2008;15:80–87.

    Article  PubMed  Google Scholar 

  16. Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–1137.

    Article  PubMed  Google Scholar 

  17. Verhorf C, van de Weyer R, Schaapveld M, Bastiaannet E, Plukker JTM. Better survival in patients with oesophageal cancer after surgical treatment in University hospitals: A plea for performance by surgical oncologists. Ann Surg Oncol 2007;14:1678–1687.

    Article  Google Scholar 

  18. International Agency for Research on Cancer. Manual for Cancer Registry Personnel: IARC Technical Report No 10. Lyon: IARC; 1995 Contract No.: Document Number|.

  19. Barraclough H, Morrell S, Arcorace M, McElroy H, Baker DF. Degree-of-spread artefact in the New South Wales Central Cancer Registry. Aust NZ J Public Health 2008;32:414–416.

    Article  Google Scholar 

  20. International Agency for Research on Cancer, World Health Organization, International Association of Cancer Registries. Chapter 4—Coding. In: Esteban D, Whelan S, Laudico A, Parkin D, eds. Manual for Cancer Registry Personnel: IARC Technical Report No. 10 Lyon: International Agency for Research on Cancer; 1995, p. 4.32.

  21. ChoiceMaker Technologies I. New York, NY 10010.

  22. GISCA. About ARIA+ (Accessibility/Remoteness Index of Australia). 2006 [updated 2006; cited 01/08/07]. Available from: www.gisca.adelaide.edu.au/products_services/ariav2_about.html.

  23. Pink B. An Introduction to Socio-Economic Indexes for Areas (SEIFA). Information Paper. Canberra: Australian Bureau of Statistics; 2006. Report No.: ABS Catalogue No. 2039.0 Contract No.: Document Number|.

  24. National Centre for Classification in Health. ICD-10-AM/ACHI/ACS. Sixth Edition. University of Sydney; 2008 [cited].

  25. Gillison EW, Powell J, McConkey CC, Spychal RT. Surgical workload and outcome after resection for carcinoma of the oesophagus and cardia. Br J Surg. 2002;89:344–348.

    Article  CAS  PubMed  Google Scholar 

  26. Allum WH, Griffin SM, Watson A, Colin-Jones D. Guidelines for the management of oesophageal and gastric cancer. Gut. 2002;50 (Supplement 5):v1–v23.

    PubMed  Google Scholar 

  27. McCulloch P, Ward J, Tekkis PP. Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ. 2003;327:1192–1197.

    Article  PubMed  Google Scholar 

  28. Epari K, Cade R. Oesophagectomy for tumours and dysplasia of the oesophagus and gastro-oesophageal junction. Aust NZ J Surg 2009;79:251–257.

    Article  Google Scholar 

  29. Martin DJ, Church NG, Kennedy CW, Falk GL. Does systematic 2-field lymphadenectomy for esophageal malignancy offer a survival advantage? Results from 178 consecutive patients. Dis Esophagus. 2008;21:612–618.

    Article  CAS  PubMed  Google Scholar 

  30. Smith GS, Clough AD, Facek M, Berry H, Leibman S. Contemporary oesophagectomy results: outcomes from a newlyestablished surgical unit. J Gastroenterol Hepatol 2009;24 (Suppl 2):A257.

    Google Scholar 

  31. Smithers BM, Gotley DC, Martin I, Thomas JM. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg. 2007;245:232–240.

    Article  PubMed  Google Scholar 

  32. Yong EL, Han XP, Watson DI. Outcome following surgery for squamous cell carcinoma of the oesophagus. Aust NZ J Surg 2009;79:724–728.

    Article  Google Scholar 

  33. Zingg U, McQuinn A, DiValentino D, et al. Minimally invasive versus open esophagectomy for patients with esophageal cancer. Ann Thorac Surg 2009;87:911–919.

    Article  PubMed  Google Scholar 

  34. Guidance on Commisioning Cancer Services. Improving outcome in upper gastrointestinal cancer. London: NHS Executive; 2001

    Google Scholar 

  35. Killeen SD, O'Sullivan MJ, Coffey JC, Kirwan WO, Redmond HP. Provider volume and outcomes for oncological procedures. Br J Surg 2005;92:389–402.

    Article  CAS  PubMed  Google Scholar 

  36. Thompson AM, Rapson T, Gilbert FJ, Park KGM. Hospital volume does not influence long-term survival of patients undergoing surgery for oesophageal or gastric cancer. British Journal of Surgery. 2007;94:578–584.

    Article  CAS  PubMed  Google Scholar 

  37. Smith GS, Minehan E. The SUGSS database:A web based upper GI cancer database. Aust NZ J Surg 2009;79(Suppl 1):A41.

    Article  Google Scholar 

  38. Malthaner R, Collin S, Fenlon D, Rhodes S. Preoperative chemotherapy for resectable thoracic esophageal cancer. Journal [serial on the Internet]. 2006 Date; Issue 3. Art. No.: CD001556. doi:10.1002/14651858.CD001556.pub2.

Download references

Acknowledgements

The authors wish to thank CHeReL for undertaking the data linkage and Heather McElroy and Jim Bishop for their contributions.

Author information

Authors and Affiliations

  1. Cancer Institute NSW, Monitoring, Evaluation and Research Unit, PO Box 41, Alexandria, NSW, 1435, Australia

    Efty P. Stavrou & Deborah F. Baker

  2. Lowy Cancer Research Centre, UNSW, Sydney, Australia

    Efty P. Stavrou

  3. Royal North Shore Hospital, St Leonards, NSW, 2065, Australia

    Garett S. Smith

Authors
  1. Efty P. Stavrou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Garett S. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deborah F. Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Efty P. Stavrou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

P. Stavrou, E., S. Smith, G. & Baker, D.F. Surgical Outcomes Associated with Oesophagectomy in New South Wales: An Investigation of Hospital Volume. J Gastrointest Surg 14, 951–957 (2010). https://doi.org/10.1007/s11605-010-1198-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-010-1198-7

Keywords

Search

Navigation