Failure to Cure in Patients Undergoing Surgery for Esophageal Carcinoma: Hospital of Surgery Influences Prospects for Cure: A Nation-wide Cohort Study
Dutch Upper GI Cancer Audit Group
(2020) Annals of Surgery, volume 272, issue 5, pp. 744 - 750
(Article)
Abstract
OBJECTIVE: This study aimed to describe failure to cure in terms of incidence, hospital variation, and as an outcome parameter for salvage esophagectomy. SUMMARY BACKGROUND DATA: Failure to cure is a composite outcome measure that could be used for hospital comparison in esophageal carcinoma care. METHODS: All patients registered in
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the Dutch Upper GI Cancer Audit who underwent potentially curative esophageal carcinoma surgery in 2011 to 2018, were included in this nationwide cohort study. Failure to cure was defined as: 1) no surgical resection due to intraoperative metastasis or locally irresectable tumor, 2) macroscopically or microscopically incomplete resection, or 3) 30-day/in-hospital mortality. Association of baseline characteristics with failure to cure was analyzed using multivariable logistic regression in the total population and in salvage patients. RESULTS: Some 5894 patients from 22 hospitals were included, of whom 630 (10.7%) had failure to cure (hospital variation [5.5%-19.1%]). Higher age, preoperative weight loss, higher ASA-score, higher N-stage, neoadjuvant chemotherapy, or no neoadjuvant therapy (compared with neoadjuvant chemoradiotherapy), open surgery, and resection before 2014 were associated with failure to cure. After case-mix correction, 2 hospitals had statistically significant higher failure to cure percentages, whereas 2 had lower percentages. Of 151 salvage esophagectomy patients, 32.5% had failure to cure. The failure to cure rate after salvage surgery was 27.6% in high-volume hospitals and 47.6% in medium-volume hospitals. CONCLUSIONS: The incidence of failure to cure was 10.7%. Given the significant hospital variation in the percentage of failure to cure, improvement is needed. Since salvage procedures are more often successful in high-volume hospitals, further centralization of this procedure is warranted.
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Keywords: Age Factors, Aged, Chemoradiotherapy, Esophageal Neoplasms/surgery, Esophagectomy, Female, Humans, Male, Middle Aged, Neoadjuvant Therapy, Netherlands, Risk Factors, Salvage Therapy, Treatment Failure, failure to cure, unsuccessful surgery, hospital variation, hospital volume, salvage surgery, esophageal carcinoma, Surgery, Multicenter Study, Journal Article
ISSN: 0003-4932
Publisher: Lippincott Williams and Wilkins
Note: Funding Information: MIvBH is a consultant for Mylan, Johnson and Johnson, and Medtronic and received research grants from Olympus and Stryker. Publisher Copyright: © 2020 Lippincott Williams and Wilkins. All rights reserved.
(Peer reviewed)