Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study

Επιστημονική δημοσίευση - Άρθρο Περιοδικού uoadl:3196718 100 Αναγνώσεις

Μονάδα:
Ερευνητικό υλικό ΕΚΠΑ
Τίτλος:
Mortality from esophagectomy for esophageal cancer across low, middle,
and high-income countries: An international cohort study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Έτος δημοσίευσης:
2021
Συγγραφείς:
Kamarajah, S. K.
Nepogodiev, D.
Bekele, A.
Cecconello, I.
and Evans, R. P. T.
Guner, A.
Gossage, J. A.
Harustiak, T.
and Hodson, J.
Isik, A.
Kidane, B.
Leon-Takahashi, A. M. and
Mahendran, H. A.
Negoi, I.
Okonta, K. E.
Rosero, G. and
Sayyed, R. H.
Singh, P.
Takeda, F. R.
van Hillegersberg, R.
and Vohra, R. S.
White, R. E.
Griffiths, E. A.
Alderson, D.
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Evans, R. P. T.
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Griffiths, E. A.
and Jefferies, B.
Kamarajah, S. K.
McKay, S.
Mohamed, I. and
Nepogodiev, D.
Siaw-Acheampong, K.
Singh, P.
van
Hillegersberg, R.
Vohra, R.
Wanigasooriya, K.
Whitehouse, T.
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Moreno, J. I.
Takeda, F. R.
Kidane, B. and
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Bekele, A.
Kechagias, A.
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van Boxel, Gijs
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Sgromo, B.
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Humphreys, L.
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Pucher, P. and
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Mohamed, I.
Tan, B.
Abdulrahman, M. and
Vickers, J.
Akhtar, K.
Chaparala, R.
Brown, R.
Alasmar,
M. M. A.
Ackroyd, R.
Patel, K.
Tamhankar, A.
Wyman, A.
and Walker, R.
Grace, B.
Abbassi, N.
Slim, N.
Ioannidi,
L.
Blackshaw, G.
Havard, T.
Escofet, X.
Powell, A. and
Owera, A.
Rashid, F.
Jambulingam, P.
Padickakudi, J. and
Ben-Younes, H.
Mccormack, K.
Makey, I. A.
Karush, M. K. and
Seder, C. W.
Liptay, M. J.
Chmielewski, G.
Rosato, E. L. and
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Zheng, R.
Okolo, E.
Singh, A.
Scott, C. D.
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Oesophago-Gastric Anastomotic
Περιοδικό:
EJSO
Εκδότης:
Elsevier Sci Ltd, Exeter, United Kingdom
Τόμος:
47
Αριθμός / τεύχος:
6
Σελίδες:
1481-1488
Λέξεις-κλειδιά:
Global surgery; Esophagectomy; Anastomotic leak; Postoperative mortality
Επίσημο URL (Εκδότης):
DOI:
10.1016/j.ejso.2020.12.006
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