Upper Gastrointestinal Cancer Audit: A Retrospective Analysis of Patient Outcomes in North Wales

Upper gastrointestinal (UGI) cancers, including esophageal, gastroesophageal junction (GOJ), and gastric adenocarcinomas, remain clinically important malignancies associated with late presentation, multimodal treatment requirements, and treatment-related morbidity. Real-world institutional audits can help describe outcomes outside clinical trial settings and identify areas for service improvement.

The primary objective was to describe crude-documented two-year progression-free status among patients undergoing active treatment for UGI adenocarcinoma at Betsi Cadwaladr University Health Board in North Wales, United Kingdom. The secondary objectives were to describe baseline and tumor characteristics, treatment patterns, postoperative complications, and 30-day postoperative mortality.

A retrospective audit was conducted, including 78 patients with UGI cancers between January 2019 and May 2024 who received active oncological treatment. Data were extracted from institutional oncology records, multidisciplinary team documentation, pathology reports, and electronic medical records. Two-year outcome status was reported using the full audit cohort (n = 78), whereas surgical outcomes, resection margin status, pathological response, postoperative complications, and 30-day postoperative mortality were reported using the surgically treated cohort (n = 56). Because event timing, censoring, and follow-up intervals were not consistently documented, two-year progression-free status was reported as a crude descriptive outcome proportion rather than a formal Kaplan-Meier survival estimate.

Seventy-eight patients were included; the median age was 74 years, and 63 (80.8%) were male patients. Tumor sites were gastric in 50 (64.1%), esophageal in 26 (33.3%), and GOJ in two (2.6%). All 78 patients received neoadjuvant fluorouracil, leucovorin, oxaliplatin, and docetaxel chemotherapy. Surgical resection was performed in 56 out of 78 patients (71.8%). Among surgically treated patients, R0 resection was documented in 27 (48.2%), R1 resection in 11 (19.6%), and margin status was not explicitly stated in 18 (32.1%). Thirty-day postoperative mortality was one (1.8%). Retrospectively documented postoperative complications included sepsis in two (3.6%), pneumonia in one (1.8%), and anastomotic leak in one (1.8%). These complications were retrospectively classified based on available documentation; however, formal Clavien-Dindo grading could not be applied consistently due to incomplete retrospective severity documentation. Of 78 patients, crude-documented two-year progression-free status was observed in 30 patients (38.5%), 32 (41.0%) had documented progression or death within two years, and 16 (20.5%) were not evaluable due to incomplete follow-up documentation.

This retrospective institutional audit provides descriptive real-world data on treatment patterns and documented outcomes among patients with UGI adenocarcinoma managed within a National Health Service health board. The findings should be interpreted as descriptive audit data rather than evidence of treatment efficacy or equivalence with clinical trial outcomes. Prospective data collection with standardized recording of performance status, comorbidity, treatment completion, dose modifications, surgical procedure type, complication grading, follow-up duration, and time-to-event outcomes would strengthen future evaluation of this cohort.