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.
Keywords
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Article info
Publication history
Published online: December 31, 2020
Accepted:
December 9,
2020
Identification
Copyright
© 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
