P21 Textbook outcome following oesophagectomy for cancer: an international cohort study

Abstract

Abstract Introduction Although textbook outcome (TO) has been proposed as a tool for the assessment of oncological surgical care, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess TO in an international setting. Methods Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 - December 2018. TO was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with TO, and results are presented as odds ratio (OR) and 95% confidence intervals (CI95%). Results Of 2,159 patients with oesophageal cancer, 39.7% achieved a TO. The outcome parameter ‘no major postoperative complication’ had greatest negative impact on a TO for patients with oesophageal cancer, compared to other TO parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of TO. Presence of 24-hour on-call rota for oesophageal surgeons (OR: 2.05, CI95%: 1.30–3.22, p=0.002) and radiology (OR: 1.54, CI95%: 1.05–2.24, p=0.027), total minimally invasive esophagectomies (OR: 1.63, CI95%: 1.27–2.08, p<0.001), and chest anastomosis above azygous (OR: 2.17, CI95%: 1.58–2.98, p<0.001) were independently associated with a significantly increased likelihood of TO. Conclusion TO is achieved in less than 40% of patients having oesophagectomy for cancer. Improvements in centralisation, hospital resources (i.e. daily 24-hour on-call esophagogastric surgeons and radiologists), access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve TO. Understanding how these individual parameters help improve quality of patient care should be the focus of future research.