@article{3196718,
    title = "Mortality from esophagectomy for esophageal cancer across low, middle,
and high-income countries: An international cohort study",
    author = "Kamarajah, S. K. and Nepogodiev, D. and Bekele, A. and Cecconello, I. and and Evans, R. P. T. and Guner, A. and Gossage, J. A. and Harustiak, T. and and Hodson, J. and Isik, A. and Kidane, B. and Leon-Takahashi, A. M. and and Mahendran, H. A. and Negoi, I. and Okonta, K. E. and Rosero, G. and and Sayyed, R. H. and Singh, P. and Takeda, F. R. and van Hillegersberg, R. and and Vohra, R. S. and White, R. E. and Griffiths, E. A. and Alderson, D. and and Bundred, J. and Evans, R. P. T. and Gossage, J. and Griffiths, E. A. and and Jefferies, B. and Kamarajah, S. K. and McKay, S. and Mohamed, I. and and Nepogodiev, D. and Siaw-Acheampong, K. and Singh, P. and van and Hillegersberg, R. and Vohra, R. and Wanigasooriya, K. and Whitehouse, T. and and Gjata, A. and Moreno, J. I. and Takeda, F. R. and Kidane, B. and and Guevara, Castro R. and Harustiak, T. and Bekele, A. and Kechagias, A. and and Gockel, I. and Kennedy, A. and Da Roit, A. and Bagajevas, A. and and Azagra, J. S. and Mahendran, H. A. and Mejia-Fernandez, L. and and Wijnhoven, B. P. L. and El Kafsi, J. and Sayyed, R. H. and Sousa, M. and and Sampaio, A. S. and Negoi, I. and Blanco, R. and Wallner, B. and and Schneider, P. M. and Hsu, P. K. and Isik, A. and Gananadha, S. and and Wills, V. and Devadas, M. and Duong, C. and Talbot, M. and Hii, M. W. and and Jacobs, R. and Andreollo, N. A. and Johnston, B. and Darling, G. and and Isaza-Restrepo, A. and Rosero, G. and Arias-Amezquita, F. and Raptis, D. and and Gaedcke, J. and Reim, D. and Izbicki, J. and Egberts, J. H. and and Dikinis, S. and Kjaer, D. W. and Larsen, M. H. and Achiam, M. P. and and Saarnio, J. and Theodorou, D. and Liakakos, T. and Korkolis, D. P. and and Robb, W. B. and Collins, C. and Murphy, T. and Reynolds, J. and Tonini, and V. and Migliore, M. and Bonavina, L. and Valmasoni, M. and Bardini, R. and and Weindelmayer, J. and Terashima, M. and White, R. E. and Alghunaim, and E. and Elhadi, M. and Leon-Takahashi, A. M. and Medina-Franco, H. and and Lau, P. C. and Okonta, K. E. and Heisterkamp, J. and Rosman, C. and van and Hillegersberg, R. and Beban, G. and Babor, R. and Gordon, A. and and Rossaak, J. I. and Pal, K. M. I. and Qureshi, A. U. and Naqi, S. A. and and Syed, A. A. and Barbosa, J. and Vicente, C. S. and Leite, J. and Freire, and J. and Casaca, R. and Costa, R. C. T. and Scurtu, R. R. and Mogoanta, S. and S. and Bolca, C. and Constantinoiu, S. and Sekhniaidze, D. and Bjelovic, and M. and So, J. B. Y. and Gacevski, G. and Loureiro, C. and Pera, M. and and Bianchi, A. and Moreno, Gijon M. and Martin Fernandez, J. and Carrera, and M. S. Trugeda and Vallve-Bernal, M. and Pascual, M. A. Citores and and Elmahi, S. and Halldestam, I. and Hedberg, J. and Monig, S. and and Gutknecht, S. and Tez, M. and Guner, A. and Tirnaksiz, M. B. and Colak, and E. and Sevinc, B. and Hindmarsh, A. and Khan, I. and Khoo, D. and Byrom, and R. and Gokhale, J. and Wilkerson, P. and Jain, P. and Chan, D. and and Robertson, K. and Iftikhar, S. and Skipworth, R. and Forshaw, M. and and Higgs, S. and Gossage, J. and Nijjar, R. and Viswanath, Y. K. S. and and Turner, P. and Dexter, S. and Boddy, A. and Allum, W. H. and Oglesby, S. and and Cheong, E. and Beardsmore, D. and Vohra, R. and Maynard, N. and and Berrisford, R. and Mercer, S. and Puigt, S. and Melhadot, R. and Kelty, and C. and Underwood, T. and Dawas, K. and Lewis, W. and Al-Bahrani, A. and and Bryce, G. and Thomas, M. and Arndt, A. T. and Palazzo, F. and Meguid, R. and A. and Fergusson, J. and Beenen, E. and Mosse, C. and Salim, J. and and Cheah, S. and Wright, T. and Cerdeira, M. P. and McQuillan, P. and and Richardson, M. and Liem, H. and Spillane, J. and Yacob, M. and Albadawi, and F. and Thorpe, T. and Dingle, A. and Cabalag, C. and Loi, K. and Fisher, and O. M. and Ward, S. and Read, M. and Johnson, M. and Bassari, R. and Bui, and H. and Cecconello, I. and Sallum, R. A. A. and da Rocha, J. R. M. and and Lopes, L. R. and Tercioti, Jr., V. and Coelho, J. D. and Ferrer, J. A. and P. and Buduhan, G. and Tan, L. and Srinathan, S. and Shea, P. and Yeung, and J. and Allison, F. and Carroll, P. and Vargas-Barato, F. and Gonzalez, and F. and Ortega, J. and Nino-Torres, L. and Beltran-Garcia, T. C. and and Castilla, L. and Pineda, M. and Bastidas, A. and Gomez-Mayorga, J. and and Cortes, N. and Cetares, C. and Caceres, S. and Duarte, S. and Pazdro, A. and and Snajdauf, M. and Faltova, H. and Sevcikova, M. and Mortensen, P. B. and and Katballe, N. and Ingemann, T. and Morten, B. and Kruhlikava, I. and and Ainswort, A. P. and Stilling, N. M. and Eckardt, J. and Holm, J. and and Thorsteinsson, M. and Siemsen, M. and Brandt, B. and Nega, B. and and Teferra, E. and Tizazu, A. and Kauppila, J. H. and Koivukangas, V. and and Merilainen, S. and Gruetzmann, R. and Krautz, C. and Weber, G. and and Golcher, H. and Emons, G. and Azizian, A. and Ebeling, M. and Niebisch, and S. and Kreuser, N. and Albanese, G. and Hesse, J. and Volovnik, L. and and Boecher, U. and Reeh, M. and Triantafyllou, S. and Schizas, D. and and Michalinos, A. and Mpali, E. and Mpoura, M. and Charalabopoulos, A. and and Manatakis, D. K. and Balalis, D. and Bolger, J. and Baban, C. and and Mastrosimone, A. and McAnena, O. and Quinn, A. and Suilleabhain, C. B. and O. and Hennessy, M. M. and Ivanovski, I. and Khizer, H. and Ravi, N. and and Donlon, N. and Cervellera, M. and Vaccari, S. and Bianchini, S. and and Sartarelli, L. and Asti, E. and Bernardi, D. and Merigliano, S. and and Provenzano, L. and Scarpa, M. and Saadeh, L. and Salmaso, B. and De and Manzoni, G. and Giacopuzzi, S. and La Mendola, R. and De Pasqual, C. A. and and Tsubosa, Y. and Niihara, M. and Irino, T. and Makuuchi, R. and and Ishii, K. and Mwachiro, M. and Fekadu, A. and Odera, A. and Mwachiro, E. and and AlShehab, D. and Ahmed, H. A. and Shebani, A. O. and Elhadi, A. and and Elnagar, F. A. and Elnagar, H. F. and Makkai-Popa, S. T. and Wong, L. F. and and Tan, Y. R. and Thannimalai, S. and Ho, C. A. and Pang, W. S. and and Tan, J. H. and Basave, H. N. L. and Cortes-Gonzalez, R. and Lagarde, S. and M. and van Lanschot, J. J. B. and Cords, C. and Jansen, W. A. and and Martijnse, I. and Matthijsen, R. and Bouwense, S. and Klarenbeek, B. and and Verstegen, M. and van Workum, F. and Ruurda, J. P. and van der Sluis, P. and C. and de Maat, M. and Evenett, N. and Johnston, P. and Patel, R. and and MacCormick, A. and Young, M. and Smith, B. and Ekwunife, C. and Memon, and A. H. and Shaikh, K. and Wajid, A. and Khalil, N. and Haris, M. and and Mirza, Z. U. and Qudus, S. B. A. and Sarwar, M. Z. and Shehzadi, A. and and Raza, A. and Jhanzaib, M. H. and Farmanali, J. and Zakir, Z. and and Shakeel, O. and Nasir, I. and Khattak, S. and Baig, M. and Noor, M. A. and and Ahmed, H. H. and Naeem, A. and Pinho, A. C. and da Silva, R. and and Bernardes, A. and Campos, J. C. and Matos, H. and Braga, T. and and Monteiro, C. and Ramos, P. and Cabral, F. and Gomes, M. P. and Martins, and P. C. and Correia, A. M. and Videira, J. F. and Ciuce, C. and Drasovean, and R. and Apostu, R. and Ciuce, C. and Paitici, S. and Racu, A. E. and and Obleaga, C. V. and Beuran, M. and Stoica, B. and Ciubotaru, C. and and Negoita, V. and Cordos, I. and Birla, R. D. and Predescu, D. and Hoara, and P. A. and Tomsa, R. and Shneider, V. and Agasiev, M. and Ganjara, I. and and Gunjic, D. and Veselinovic, M. and Babic, T. and Chin, T. S. and and Shabbir, A. and Kim, G. and Crnjac, A. and Samo, H. and Del Val, I. Diez and and Leturio, S. and Ramon, J. M. and Dal Cero, M. and Rifa, S. and Rico, and M. and Pomar, A. Pagan and Corcoles, J. A. Martinez and Miravalles, J. and L. Rodicio and Pais, S. A. and Turienzo, S. A. and Alvarezt, L. S. and and Alvarez, L. S. and Campos, P. V. and Rendo, A. G. and Garcia, S. S. and and Santos, E. P. G. and Martinez, E. T. and Fernandez, Diaz Mj and Magadan, and Alvarez C. and Concepcion, Martin V. and Diaz, Lopez C. and Rosat, and Rodrigo A. and Perez, Sanchez L. E. and Bailon, Cuadrado M. and Tinoco, and Carrasco C. and Bhojwani, E. Choolani and Sanchez, D. 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C. and and McLaughlin, E. and Koshy, R. and Sharp, C. and Brewer, H. and Das, N. and and Cox, M. and Al Khyatt, W. and Worku, D. and Iqbal, R. and Walls, L. and and McGregor, R. and Fullarton, G. and Macdonald, A. and MacKay, C. and and Craig, C. and Dwerryhouse, S. and Hornby, S. and Jaunoo, S. and Wadley, and M. and Baker, C. and Saad, M. and Kelly, M. and Davies, A. and Di and Maggio, F. and McKay, S. and Mistry, P. and Singhal, R. and Tucker, O. and and Kapoulas, S. and Powell-Brett, S. and Davis, P. and Bromley, G. and and Watson, L. and Verma, R. and Ward, J. and Shetty, V. and Ball, C. and and Pursnani, K. and Sarela, A. and Sue, Ling H. and Mehta, S. and Hayden, and J. and To, N. and Palser, T. and Hunter, D. and Supramaniam, K. and and Butt, Z. and Ahmed, A. and Kumar, S. and Chaudry, A. and Moussa, O. and and Kordzadeh, A. and Lorenzi, B. and Wilson, M. and Patil, P. and Noaman, and I. and Willem, J. and Bouras, G. and Evans, R. and Singh, M. and and Warrilow, H. and Ahmad, A. and Tewari, N. and Yanni, F. and Couch, J. and and Theophilidou, E. and Reilly, J. J. and Singh, P. and van Boxel, Gijs and and Akbari, K. and Zanotti, D. and Sgromo, B. and Sanders, G. and and Wheatley, T. and Ariyarathenam, A. and Reece-Smith, A. and Humphreys, L. and and Choh, C. and Carter, N. and Knight, B. and Pucher, P. and and Athanasiou, A. and Mohamed, I. and Tan, B. and Abdulrahman, M. and and Vickers, J. and Akhtar, K. and Chaparala, R. and Brown, R. and Alasmar, and M. M. A. and Ackroyd, R. and Patel, K. and Tamhankar, A. and Wyman, A. and and Walker, R. and Grace, B. and Abbassi, N. and Slim, N. and Ioannidi, and L. and Blackshaw, G. and Havard, T. and Escofet, X. and Powell, A. and and Owera, A. and Rashid, F. and Jambulingam, P. and Padickakudi, J. and and Ben-Younes, H. and Mccormack, K. and Makey, I. A. and Karush, M. K. and and Seder, C. W. and Liptay, M. J. and Chmielewski, G. and Rosato, E. L. and and Berger, A. C. and Zheng, R. and Okolo, E. and Singh, A. and Scott, C. D. and and Weyant, M. J. and Mitchell, J. D. and Oesophago-Gastric Anastomotic",
    journal = "EJSO",
    year = "2021",
    volume = "47",
    number = "6",
    pages = "1481-1488",
    publisher = "Elsevier Sci Ltd, Exeter, United Kingdom",
    doi = "10.1016/j.ejso.2020.12.006",
    keywords = "Global surgery; Esophagectomy; Anastomotic leak; Postoperative mortality",
    abstract = "Background: No evidence currently exists characterising global outcomes
following major cancer surgery, including esophageal cancer. Therefore,
this study aimed to characterise impact of high income countries (HIC)
versus low and middle income countries (LMIC) on the outcomes following
esophagectomy for esophageal cancer.
Method: This international multi-center prospective study across 137
hospitals in 41 countries included patients who underwent an
esophagectomy for esophageal cancer, with 90-day follow-up. The main
explanatory variable was country income, defined according to the World
Bank Data classification. The primary outcome was 90-day postoperative
mortality, and secondary outcomes were composite leaks (anastomotic leak
or conduit necrosis) and major complications (Clavien-Dindo Grade
III-V). Multivariable generalized estimating equation models were used
to produce adjusted odds ratios (ORs) and 95% confidence intervals
(CI95%).
Results: Between April 2018 to December 2018, 2247 patients were
included. Patients from HIC were more significantly older, with higher
ASA grade, and more advanced tumors. Patients from LMIC had almost
three-fold increase in 90-day mortality, compared to HIC (9.4% vs
3.7%, p < 0.001). On adjusted analysis, LMIC were independently
associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p
= 0.015). However, LMIC were not independently associated with higher
rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or
major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to
HIC.
Conclusion: Resections in LMIC were independently associated with higher
90-day postoperative mortality, likely reflecting a failure to rescue of
these patients following esophagectomy, despite similar composite
anastomotic leaks and major complication rates to HIC. These findings
warrant further research, to identify potential issues and solutions to
improve global outcomes following esophagectomy for cancer. (C) 2020
Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and
the European Society of Surgical Oncology. All rights reserved."
}