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ANZMOSS - ANZGOSA 2020 Virtual Conference
ANZMOSS – ANZGOSA 2020 Virtual Conference
ANZMOSS - ANZGOSA 2020 Virtual Conference
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Oesophagectomy in Southern New Zealand: A twenty-five year audit

Presentation Description

BACKGROUND
Over the last two decades, outcomes for oesophageal cancer have improved due to advances in surgical and oncological practice. Optimising outcomes by centralisation of oesophagectomy to high volume centres has been observed. The aim of this study was to establish if technical and oncological outcomes after oesophagectomy in southern New Zealand are comparable to recent benchmarks.  

METHODS
Consecutive patients undergoing oesophagectomy for cancer and benign pathology at Dunedin Hospital from 1995 to 2019 were prospectively audited. For malignant cases, histology was obtained retrospectively along with details of neo-adjuvant and adjuvant therapy. The primary outcome was disease specific survival, stratified by time, resection margin, and TNM staging.  Secondary outcomes included mortality and morbidity of oesophagectomy.  Complications were graded using the Clavien-Dindo classification.

RESULTS
Oesophagectomy was performed in 108 patients, and 99 patients had surgery for oesophageal malignancy. The median survival was 35.3 (95 % CI 30.0,93.4) months and the five year survival overall was 41.7%.  Comparing survival in patients undergoing oesophagectomy up to 2006 and afterwards showed an improvement in 5-year survival (30.3%, 95%CI[14.2,60.0] vs 47.8%, 95%CI[32.5, not reached]) respectively, p=.041). There were two perioperative deaths (1.8 %), six clinical anastomotic leaks (5.5%), four anastomotic strictures, (3.7%) and five chylothoraces (4.6%).  

CONCLUSION
This 25-year survey of oesophagectomy in Southern New Zealand audits the results of a low volume centre, where a variety of neo-adjuvant treatments have been used. Despite this, perioperative morbidity, mortality, and survival are comparable to those achieved by international high-volume centres.

Authors

Sonal Nagra - University Hospital Geelong Aleksandra Popadich - Capital and Coast District Health Board Kari Clifford - University of Otago Ryan Cha - Southern District Health Board Thomas Bartlett Elliott - Southern District Health Board