Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study
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Kamarajah, S.K. and Nepogodiev, D. and Bekele, A. and Cecconello, I. and Evans, R.P.T. and Guner, A. and Gossage, J.A. and Harustiak, T. and Hodson, J. and Isik, A. and Kidane, B. and Leon-Takahashi, A.M. and Mahendran, H.A. and Negoi, I. and Okonta, K.E. and Rosero, G. and Sayyed, R.H. and Singh, P. and Takeda, F.R. and van Hillegersberg, R. and Vohra, R.S. and White, R.E. and Griffiths, E.A. and Alderson, D. and Bundred, J. and Gossage, J. and Jefferies, B. and McKay, S. and Mohamed, I. and Siaw- Acheampong, K. and Vohra, R. and Wanigasooriya, K. and Whitehouse, T. and Gjata, A. and Moreno, J.I. and Guevara, C.R. and Kechagias, A. and Gockel, I. and Kennedy, A. and Da Roit, A. and Bagajevas, A. and Azagra, J.S. and Mej??a-Fern??ndez, L. and Wijnhoven, B.P.L. and El Kafsi, J. and Sousa, M. and Sampaio, A.S. and Blanco, R. and Wallner, B. and Schneider, P.M. and Hsu, P.K. and Gananadha, S. and Wills, V. and Devadas, M. and Duong, C. and Talbot, M. and Hii, M.W. and Jacobs, R. and Andreollo, N.A. and Johnston, B. and Darling, G. and Isaza-Restrepo, A. and Arias- Am??zquita, F. and Raptis, D. and Gaedcke, J. and Reim, D. and Izbicki, J. and Egberts, J.H. and Dikinis, S. and Kjaer, D.W. and Larsen, M.H. and Achiam, M.P. and Saarnio, J. and Theodorou, D. and Liakakos, T. and Korkolis, D.P. and Robb, W.B. and Collins, C. and Murphy, T. and Reynolds, J. and Tonini, V. and Migliore, M. and Bonavina, L. and Valmasoni, M. and Bardini, R. and Weindelmayer, J. and Terashima, M. and Alghunaim, E. and Elhadi, M. and Medina-Franco, H. and Lau, P.C. and Heisterkamp, J. and Rosman, C. and Beban, G. and Babor, R. and Gordon, A. and Rossaak, J.I. and Pal, K.M.I. and Qureshi, A.U. and Naqi, S.A. and Syed, A.A. and Barbosa, J. and Vicente, C.S. and Leite, J. and Freire, J. and Casaca, R. and Costa, R.C.T. and Scurtu, R.R. and Mogoanta, S.S. and Bolca, C. and Constantinoiu, S. and Sekhniaidze, D. and Bjelovi??, M. and So, J.B.Y. and Ga??evski, G. and Loureiro, C. and Pera, M. and Bianchi, A. and Moreno, G.M. and Mart??n Fern??ndez, J. and Trugeda Carrera, M.S. and Vallve-Bernal, M. and C??tores Pascual, M.A. and Elmahi, S. and Halldestam, I. and Hedberg, J. and M??nig, S. and Gutknecht, S. and Tez, M. and Tirnaksiz, M.B. and Colak, E. and Sevin??, B. and Hindmarsh, A. and Khan, I. and Khoo, D. and Byrom, R. and Gokhale, J. and Wilkerson, P. and Jain, P. and Chan, D. and Robertson, K. and Iftikhar, S. and Skipworth, R. and Forshaw, M. and Higgs, S. and Nijjar, R. and Viswanath, Y.K.S. and Turner, P. and Dexter, S. and Boddy, A. and Allum, W.H. and Oglesby, S. and Cheong, E. and Beardsmore, D. and Maynard, N. and Berrisford, R. and Mercer, S. and Puig, S. and Melhado, R. and Kelty, C. and Underwood, T. and Dawas, K. and Lewis, W. and Al-Bahrani, A. and Bryce, G. and Thomas, M. and Arndt, A.T. and Palazzo, F. and Meguid, R.A. and Fergusson, J. and Beenen, E. and Mosse, C. and Salim, J. and Cheah, S. and Wright, T. and Cerdeira, M.P. and McQuillan, P. and Richardson, M. and Liem, H. and Spillane, J. and Yacob, M. and Albadawi, F. and Thorpe, T. and Dingle, A. and Cabalag, C. and Loi, K. and Fisher, O.M. and Ward, S. and Read, M. and Johnson, M. and Bassari, R. and Bui, H. and Sallum, R.A.A. and da Rocha, J.R.M. and Lopes, L.R. and Tercioti, V. and Coelho, J.D. and Ferrer, J.A.P. and Buduhan, G. and Tan, L. and Srinathan, S. and Shea, P. and Yeung, J. and Allison, F. and Carroll, P. and Vargas-Barato, F. and Gonzalez, F. and Ortega, J. and Nino-Torres, L. and Beltr??n-Garc??a, T.C. and Castill, Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study, European Journal of Surgical Oncology, 2021Download Item:
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.
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http://dx.doi.org/10.1016/j.ejso.2020.12.006Metadata
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