L A Busweiler1, D Henneman2, J L Dikken3, M Fiocco4, M I van Berge Henegouwen5, B P Wijnhoven6, R van Hillegersberg7, C Rosman8, M W Wouters9, J W van Sandick10. 1. Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: l.a.d.busweiler@lumc.nl. 2. Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. 3. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Surgery, Medical Center Haaglanden, The Hague, The Netherlands. 4. Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands; Mathematical Institute, Leiden University, Leiden, The Netherlands. 5. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. 6. Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. 7. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 8. Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. 9. Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 10. Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Complex surgical procedures such as esophagectomy and gastrectomy for cancer are associated with substantial morbidity and mortality. The purpose of this study was to evaluate trends in postoperative morbidity, mortality, and associated failure-to-rescue (FTR), in patients who underwent a potentially curative resection for esophageal or gastric cancer in the Netherlands, and to investigate differences between the two groups. METHODS: All patients with esophageal or gastric cancer who underwent a potentially curative resection, registered in the Dutch Upper GI Cancer Audit (DUCA) between 2011 and 2014, were included. Primary outcomes were (major) postoperative complications, postoperative mortality and FTR. To investigate groups' effect on the outcomes of interest a mixed model was used. RESULTS: Overall, 2644 patients with esophageal cancer and 1584 patients with gastric cancer were included in this study. In patients with gastric cancer, postoperative mortality (7.7% in 2011 vs. 3.8% in 2014) and FTR (38% in 2011 and 19% in 2014) decreased significantly over the years. The adjusted risk of developing a major postoperative complication was lower (OR 0.54; 95% CI 0.42-0.70), but the risk of FTR was higher (OR 1.85; 95% CI 1.05-3.27) in patients with gastric cancer compared to patients with esophageal cancer. CONCLUSION: Once a postoperative complication occurred, patients with gastric cancer were more likely to die compared to patients with esophageal cancer. Underlying mechanisms like patient selection, and differences in structure and organization of care should be investigated. Next to morbidity and mortality, failure-to-rescue should be considered as an important outcome measure after esophagogastric cancer resections.
BACKGROUND: Complex surgical procedures such as esophagectomy and gastrectomy for cancer are associated with substantial morbidity and mortality. The purpose of this study was to evaluate trends in postoperative morbidity, mortality, and associated failure-to-rescue (FTR), in patients who underwent a potentially curative resection for esophageal or gastric cancer in the Netherlands, and to investigate differences between the two groups. METHODS: All patients with esophageal or gastric cancer who underwent a potentially curative resection, registered in the Dutch Upper GI Cancer Audit (DUCA) between 2011 and 2014, were included. Primary outcomes were (major) postoperative complications, postoperative mortality and FTR. To investigate groups' effect on the outcomes of interest a mixed model was used. RESULTS: Overall, 2644 patients with esophageal cancer and 1584 patients with gastric cancer were included in this study. In patients with gastric cancer, postoperative mortality (7.7% in 2011 vs. 3.8% in 2014) and FTR (38% in 2011 and 19% in 2014) decreased significantly over the years. The adjusted risk of developing a major postoperative complication was lower (OR 0.54; 95% CI 0.42-0.70), but the risk of FTR was higher (OR 1.85; 95% CI 1.05-3.27) in patients with gastric cancer compared to patients with esophageal cancer. CONCLUSION: Once a postoperative complication occurred, patients with gastric cancer were more likely to die compared to patients with esophageal cancer. Underlying mechanisms like patient selection, and differences in structure and organization of care should be investigated. Next to morbidity and mortality, failure-to-rescue should be considered as an important outcome measure after esophagogastric cancer resections.
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