Evaluation of oesophageal and gastric resection outcomes in a small-volume unit

Oesophagogastric resections continue to be a major surgical challenge with high morbidity, this has led to a worldwide trend for centralisation of these complex surgeries. However, there is no clear agreement on what constitutes a high-volume centre, leading to worldwide disparity. We evaluate our experience of oesophagogastric resection in a small volume unit to seek other factors that influence patient outcome.

We analysed 173 consecutive oesophagogastric resection from 2010 to 2020. The primary outcome was 30-day mortality and secondary outcome included peri-operative morbidity, length of stay, lymph node harvest, R0 resection. Collected continuous data were compared using the Mann-Whitney test and categorical data using the chi-squared test and expressed as p value.

Of the 173 patients, 94 (54%) underwent hybrid minimal invasive esophagectomy (HIMO) and 79 (46%) underwent gastrectomy. 135 (78%) patients received Neoadjuvant therapy. The site of tumour was GOJ in 29%, distal stomach in 26% and distal oesophagus in 20%. Perioperative morbidity was observed in 18 (19%) after esophagectomy and 9 (11.4%) after gastrectomy. The median lymph node harvest was 18 (range 5-42) and 168 patients (97%) had longitudinal R0 resection. The most common complication was neurological seen in 3.6% followed by pulmonary complication and anastomotic leak seen in 5 patients (3%) each. The median in hospital stay was 6 days and the 30 day mortality was 2.9% with one year survival of 87%.

Small volume centres can produce comparable results. The outcomes depend on multifold parameters which include surgeon's experience in the field, ability to adhere to protocols and procedures and strong interpersonal relationship with individual patients.