Oesophagectomy at a New Zealand regional centre: where to now?

This study aims to define contemporary trends in characteristics, costs and management of patients diagnosed with oesophageal adenocarcinoma in New Zealand.

Clinical, pathological and management data of the 135 patients presenting with histologically proven adenocarcinoma to our institution over a 5-year period (January 2010 to December 2014) was collected. Primary analysis reviewed patient demographics, co-morbidities, treatment strategy and survival. Secondary analysis defined operative outcomes including complications, mortality rates and overall survival to December 2016.

Thirty-eight patients underwent oesophago-gastrectomy (resection rate 28%) with curative intent following neoadjuvant chemotherapy with Clavien-Dindo ≥3 complications in 17 patients (46%). Actuarial survivals from surgery at 1, 3 and 5 years were (79, 55 and 50%), with 19 patients (54%) alive and disease free at a median follow-up of 26.5 months (range 1-82 months). Overall, this represented one sixth of the national volume of oesophagectomy. Ninety-seven patients were managed non-surgically due to metastatic or advanced local disease (n = 64), co-morbid status (n = 27), patients choice (n = 2) and unknown (n = 4). Median survival from diagnosis in non-resected patients was 9 months (range 1-40 months).

Oesophagectomy remains a challenging procedure for any institution, although good results can be achieved. Foci for referral are emerging in New Zealand for the surgical management of oesophageal cancer.