Early impact of centralization of oesophageal cancer surgery services

Abstract

In response to national guidance, oesophageal surgery from four hospitals within Wessex was centralized to a single site, with a provision for surgeons to travel to the centre to operate if they wished. This study assessed the clinical impact of this change. Data for patients who had oesophageal cancer surgery at the single site were collected prospectively for 1 year from May 2002 and compared with the Wessex Oesophageal Cancer Audit (WOCA) data for the four hospitals from 1999 to 2000. Thirty-three patients underwent surgery on the single site compared with 40 patients from the four hospitals during the WOCA. Age, sex, co-morbidity, tumour site, and preoperative tumour and node stage were similar in the two groups. Six patients from the WOCA underwent 'open and close' laparotomy compared with none in the single-site group (P = 0.020). There were four anastomotic leaks in the WOCA group and two in the single-site group. Overall complication rates in those undergoing resection were similar in the two groups, but the in-hospital mortality rate was significantly higher in the WOCA group (five versus no patients; P = 0.022). Pathology reporting was incomplete in significantly more patients in the WOCA group (15 versus three; P = 0.001). The mean node harvest was greater in the single-site group (30.5 versus 19). Centralization of oesophageal surgery resulted in better preoperative staging, a lower 30-day mortality rate and more complete pathological reporting.