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International Variation in Surgical Practices in Units Performing Oesophagectomy for Oesophageal Cancer: A Unit Survey from the Oesophago‐Gastric Anastomosis Audit (OGAA)

2019; Springer Science+Business Media; Volume: 43; Issue: 11 Linguagem: Inglês

10.1007/s00268-019-05080-1

1432-2323

James Bundred, Sivesh K. Kamarajah, K Siaw-Acheampong, Dmitri Nepogodiev, Benjamin J Jefferies, Pritam Singh, Richard Evans, Ewen A. Griffiths, Derek Alderson, James Gossage, S McKay, Mohamed Imran, Richard van Hillegersberg, Ravinder Vohra, Kasun Wanigsooriya, Tony Whitehouse, Aleksandras Bagajevas, Abebe Bekele, Ruth Blanco‐Colino, Anna Da Roit, Jihene El Kafsi‐Mawley, Arben Gjata, Ines Gockel, Raul Guevara Castro, Tomáš Haruštiak, Po‐Kuei Hsu, Arda Işık, Aristotelis Kechagias, Andrew Kennedy, Biniam Kidane, Hans Alexander Mahendran, Loreli Mejia, J Moreno, Ionuţ Negoi, Azagra Juan Santiago, Raza Sayyed, Paul M. Schneider, António Sampaio Soares, Mariana S. Sousa, Flávio Roberto Takeda, Stephanie Vanstraten, Bengt Wallner, Bas P. L. Wijnhoven, Michael Patrick Achiam, Tita Agustin, Ali Akbar, Ahmad Al‐Bahrani, Waleed Al‐Khyatt, Markus Albertsmeier, Essa AlGhunaim, Bilal Alkhaffaf, William Allum, Fernando Am, Nelson Adami Andreollo, Andrew Arndt, Richard Babor, José Pedro Barbosa, Romeo Bardini, Duncan Beardsmore, Grant Beban, António Bernardes, Richard Berrisford, Alessandro Bianchi, Miloš Bjelović, Alex Boddy, Ciprian Bolca, Luigi Bonavina, Gavin Bryce, Richard Byrom, Rui Casaca, David Chan, Alexandros Charalabopoulos, Edward Cheong, Franco Ciotola, Elif Çolak, Chris Collins, S Constantinoiu, Rita Costa, Marc H. Dahlke, Gail Darling, Kahled Dawas, Giovanni de Manzoni, Adel Denewer, Michael Devadas, Simon Dexter, Sarunas Dikinis, Dimitrios Theodorou, James P. Dolan, Cuong Duong, Jan‐Hendrik Egberts, Y Elgharably, Muhammed Elhadi, S. Elmahi, Fernando Amézquita Farias, Enver Fekaj, Jesús Fernández, Matthew Forshaw, José Paulo Freire, Daniel French, Goran Gačevski, Jochen Gaedcke, Sivakumar Gananadha, María Moreno Gijón, Jay Gokhale, Alexandra Gordon, Peter Grimminger, Ra Guevara, Ali Güner, Stefan Gutknecht, Habibollah Mahmoodzadeh, Ingvar Halldestam, Jakob Hedberg, Joos Heisterkamp, Simon Higgs, Michael W. Hii, Andrew Hindmarsh, Jens Höppner, Andrés Isaza-Restrepo, Jakob R. Izbicki, Rod Jacobs, Prashant Jain, Jan Johansson, Brian Johnston, Jihène El Kafsi, Seyoum Kassa, C Kelty, Iftikhar Khan, David Khoo, Syed Khyatt, Daniel Willy Kjær, Dimitrios Korkolis, Nicole Kreuser, Michael Larsen, Peng Choong Lau, Júlio César Loguercio Leite, Wyn G. Lewis, Theodore Liakakos, Carlos Loureiro, Alexander Mahendran, Nicholas Maynard, R. McGregor, Stephen McNally, Heriberto Medina‐Franco, Robert A. Meguid, Rachel Melhado, Stuart Mercer, Marcello Migliore, Fernando Mingol, Stelian Ştefăniţă Mogoantă, Yasuhiko Mohri, Stefan Mönig, J. Junceda Moreno, Natalia Motaş, Thomas J. Murphy, Syed Asghar Naqi, Raj Ni, Samiullah Niazi, Stuart Oglesby, KelechiE Okonta, Susana Roldán Ortiz, Khwaja Pal, Francesco Palazzo, Andreas Pascher, Miguel Pascual, Giacomo Pata, Manuel Pera, Susana Puig, Juan Camilo Ramírez, Dimitrios Raptis, Jari Räsänen, Daniel Reim, John V. Reynolds, William Robb, Kevin Robertson, Germán Rosero, Camiel Rosman, Jeremy Rossaak, Juha Saarnio, Azagra Juan Santiago, Marc Schiesser, R R Scurtu, Dmitii Sekhniaidze, Barış Sevinç, Richard J. E. Skipworth, Jimmy Bok Yan So, Maria Soledad Trugeda, Aamir Ali Syed, A. Takahashi, Flávio Roberto Takeda, Michael Talbot, Muhammad Qasim Khan Tareen, Masanori Terashima, Mario Testini, Nila Tewari, Mesut Tez, Mathew Thomas, M.B. Tirnaksiz, Valeria Tonini, Cheng‐Che Tu, Paul Turner, Timothy J. Underwood, Uzair Ahmad, Marc Vallvè-Bernal, Michele Valmasoni, Carla Vicente, José Flávio Videira, Y K S Viswanath, Jacopo Weindelmayer, Russell E. White, Dennis A. Wigle, Paul M Wilkerson, Vanessa Wills, Emmanouil Zacharakis, Mauricio Zuluaga,

Gastric Cancer Management and Outcomes

Abstract Background Anastomotic leaks are associated with significant risk of morbidity, mortality and treatment costs after oesophagectomy. The aim of this study was to evaluate international variation in unit‐level clinical practice and resource availability for the prevention and management of anastomotic leak following oesophagectomy. Method The Oesophago‐Gastric Anastomosis Audit (OGAA) is an international research collaboration focussed on improving the care and outcomes of patients undergoing oesophagectomy. Any unit performing oesophagectomy worldwide can register to participate in OGAA studies. An online unit survey was developed and disseminated to lead surgeons at each unit registered to participate in OGAA. High‐income country (HIC) and low/middle‐income country (LMIC) were defined according to the World Bank whilst unit volume were defined as < 20 versus 20–59 versus ≥60 cases/year in the unit. Results Responses were received from 141 units, a 77% (141/182) response rate. Median annual oesophagectomy caseload was reported to be 26 (inter‐quartile range 12–50). Only 48% (68/141) and 22% (31/141) of units had an Enhanced Recovery After Surgery (ERAS) program and ERAS nurse, respectively. HIC units had significantly higher rates of stapled anastomosis compared to LMIC units (66 vs 31%, p = 0.005). Routine post‐operative contrast‐swallow anastomotic assessment was performed in 52% (73/141) units. Stent placement and interventional radiology drainage for anastomotic leak management were more commonly available in HICs than LMICs (99 vs 59%, p < 0.001 and 99 vs 83%, p < 0.001). Conclusions This international survey highlighted variation in surgical technique and management of anastomotic leak based on case volume and country income level. Further research is needed to understand the impact of this variation on patient outcomes.