PS02.166: OESOPHAGO-GASTRIC CANCER PATIENTS OPERATED ON IN THE PRIVATE SECTOR SURVIVE LONGER THAN NHS PATIENTS

Abstract

Abstract Background In the UK, national directives have resulted in centralisation of oesophago-gastric cancer in large National Health Service (NHS) centres. NHS cancer centres have treatment pathway targets of 30 and 60 days to complete staging and start treatment. We have treated patients with oesophago-gastric cancer both in the NHS and private sector. The purpose of this study was to assess whether the treatment and outcome was different for patients treated in the private sector. Methods Data was collected prospectively of consecutive oesophago-gastrectomies for OGJ cancer performed by a single surgeon from 2003–2013. After diagnosis all cases were discussed in a multi-disciplinary meeting. Neo-adjuvant chemotherapy was offered to all patients deemed to have N1 or T3 disease according to MAGIC and OEO5 study protocols. Patients in these stage groups who declined neo-adjuvant chemotherapy were offered adjuvant chemotherapy or chemo-radiation. During the first 2 years oesophago-gastrectomy was performed by open surgery, where-after laparoscopic and thoracoscopic techniques were introduced. Data analysis was by logistic regression using SPSS software. Results 204 resections for OGJ cancer were performed during. The average age was 63 years (range 41–82), 85% had adenocarcinoma, and 78% of patients received neo-adjuvant chemotherapy. The pathological staging was pN1 64%, pT0 5%, pT1 17%, pT2 32%, pT3 42%, pT4 3%. The median hospital stay was 14 days (range 6–210), and the in-hospital mortality was 2.5%. 40 patients had their treatment in private hospitals. There was no difference in the demographics, histology, tumour stage, percentage receiving chemotherapy, type of chemotherapy or surgery between private and NHS patients. Private patients completed their staging tests within 9 days (range 126) of endoscopy and started definitive treatment within 10 days (range 2–59) of the last staging test. 26 of the 40 patients (65%) operated on in the private sector survived 5 years which was more than the 39% of NHS patients who survived 5 years (P = 0.0084). Conclusion Treatment for oesophago-gastric cancer is evolving. Patients with oesophago-gastric cancer treated in the private sector have better long-term survival than NHS patients which might be related to their shorter treatment pathway. Further studies will elucidate the changes in treatment required to improve survival for all UK patients with oesophago-gastric cancer. Disclosure All authors have declared no conflicts of interest.