International Variation in Surgical Practices in Units Performing Oesophagectomy for Oesophageal Cancer: A Unit Survey from the Oesophago‐Gastric Anastomosis Audit (OGAA)
Authors:   Oesophago‐Gastric Anastomosis Study Group on behalf of the West Midlands Research Collaborative, Bundred James R. , Kamarajah Sivesh K. , Siaw‐Acheampong Kobby , Nepogodiev Dmitri , Jefferies Benjamin , Singh Pritam , Evans Richard , Griffiths Ewen A. , Alderson Derek , Gossage James , McKay Siobhan , Mohamed Imran , van Hillegersberg Richard , Vohra Ravinder , Wanigsooriya Kasun , Whitehouse Tony , Bagajevas Aleksandras , Bekele Abebe , Blanco‐Colino Ruth , Da Roit Anna , El Kafsi‐Mawley Jihene , Gjata Arben , Gockel Ines , Castro Raul Guevara , Harustiak Tomas , Hsu Po‐Kuei , Isik Arda , Kechagias Aristotelis , Kennedy Andrew , Kidane Biniam , Mahendran Hans Alexander , Mejia Loreli , Moreno Jorge Ignacio , Negoi Ionut , Santiago Azagra Juan , Sayyed Raza , Schneider Paul , Soares António Sampaio , Sousa Mariana , Takeda Flavio Roberto , Vanstraten Stephanie , Wallner Bengt , Wijnhoven Bas , Achiam Michael , Agustin Tita , Akbar Ali , Al‐Bahrani Ahmad , Al‐Khyatt Waleed , Albertsmeier Markus , Alghunaim Essa , Alkhaffaf Bilal , Allum William , Am Fernando , Andreollo Nelson , Arndt Andrew , Babor Richard , Barbosa Jose , Bardini Romeo , Beardsmore Duncan , Beban Grant , Bernardes Antonio , Berrisford Richard , Bianchi Alessandro , Bjelovic Milos , Boddy Alex , Bolca Ciprian , Bonavina Luigi , Bryce Gavin , Byrom Richard , Casaca Rui , Chan David , Charalabopoulos Alexandros , Cheong Edward , Ciotola Franco , Colak Elif , Collins Chris , Constantinoiu Silviu , Costa Rita , Dahlke Marc , Darling Gail , Dawas Kahled , de Manzoni Giovanni , Denewer Adel , Devadas Michael , Dexter Simon , Dikinis Sarunas , Dimitrios Theodorou , Dolan James , Duong Cuong , Egberts Jan‐Hendrik , Elgharably Yasser , Elhadi Muhammed , Elmahi Seifeldin , Farias Fernando Amézquita , Fekaj Enver , Fernández Jesus , Forshaw Matthew , Freire Jose , French Daniel , Gacevski Goran , Gaedcke Jochen , Gananadha Sivakumar , Gijon Maria Moreno , Gokhale Jay , Gordon Alexandra , Grimminger Peter , Guevara Ra , Guner Ali , Gutknecht Stefan , Mahmoodzadeh Habibollah , Halldestam Ingvar , Hedberg Jakob , Heisterkamp Joos , Higgs Simon , Hii Michael , Hindmarsh Andrew , Hoppner Jens , Isaza Andres , Izbicki Jakob , Jacobs Rod , Jain Prashant , Johansson Jan , Johnston Brian , Kafsi Jihene , Kassa Seyoum , Kelty Clive , Khan Iftikhar , Khoo David , Khyatt Syed , Kjaer Daniel , Korkolis Dimitrios , Kreuser Nicole , Larsen Michael , Lau Peng , Leite Julio , Lewis Wyn , Liakakos Theodore , Loureiro Carlos , Mahendran Alexander , Maynard Nicholas , Mcgregor Richard , Mcnally Stephen , Medina‐Franco Heriberto , Meguid Robert , Melhado Rachel , Mercer Stuart , Migliore Marcello , Mingol Fernando , Mogoanta Stelian , Mohri Yasuhiko , Mönig Stefan , Moreno Jorge , Motas Natalia , Murphy Thomas , Naqi Syed , Ni Raj , Niazi Samiullah , Oglesby Stuart , Okonta Kelechi , Ortiz Susana Roldán , Pal Khwaja , Palazzo Francesco , Pascher Andreas , Pascual Miguel , Pata Giacomo , Pera Manuel , Puig Sonia , Ramirez Juan , Raptis Dimitrios , Räsänen Jari , Reim Daniel , Reynolds John , Robb William , Robertson Kevin , Rosero German , Rosman Camiel , Rossaak Jeremy , Saarnio Juha , Santiago Azagra , Schiesser Marc , Scurtu Radu‐Razvan , Sekhniaidze Dmitii , Sevinç Bariş , Skipworth Richard , So Jimmy , Trugeda Maria Soledad , Syed Aamir , Takahashi Alberto Mitsuo Leon , Takeda Flavio , Talbot Michael , Tareen Muhammad , Terashima Masanori , Testini Mario , Tewari Nila , Tez Mesut , Thomas Mathew , Tirnaksiz Mehmet , Tonini Valeria , Tu Cheng‐Che , Turner Paul , Underwood Tim , Uzair Ahmad , Vallve‐Bernal Marc , Valmasoni Michele , Vicente Carla , Videira Jose Flavio , Viswanath YKS , Weindelmayer Jacopo , White Russell , Wigle Dennis , Wilkerson Paul , Wills Vanessa , Zacharakis Emmanouil , Zuluaga Mauricio 
Published: July 2019

Background

Anastomotic leaks are associated with significant risk of morbidity, mortality and treatment costs after oesophagectomy. The aim of this study was to evaluate international variation in unit‐level clinical practice and resource availability for the prevention and management of anastomotic leak following oesophagectomy.

Method

The Oesophago‐Gastric Anastomosis Audit (OGAA) is an international research collaboration focussed on improving the care and outcomes of patients undergoing oesophagectomy. Any unit performing oesophagectomy worldwide can register to participate in OGAA studies. An online unit survey was developed and disseminated to lead surgeons at each unit registered to participate in OGAA. High‐income country (HIC) and low/middle‐income country (LMIC) were defined according to the World Bank whilst unit volume were defined as < 20 versus 20–59 versus ≥60 cases/year in the unit.

Results

Responses were received from 141 units, a 77% (141/182) response rate. Median annual oesophagectomy caseload was reported to be 26 (inter‐quartile range 12–50). Only 48% (68/141) and 22% (31/141) of units had an Enhanced Recovery After Surgery (ERAS) program and ERAS nurse, respectively. HIC units had significantly higher rates of stapled anastomosis compared to LMIC units (66 vs 31%, p = 0.005). Routine post‐operative contrast‐swallow anastomotic assessment was performed in 52% (73/141) units. Stent placement and interventional radiology drainage for anastomotic leak management were more commonly available in HICs than LMICs (99 vs 59%, p < 0.001 and 99 vs 83%, p < 0.001).

Conclusions

This international survey highlighted variation in surgical technique and management of anastomotic leak based on case volume and country income level. Further research is needed to understand the impact of this variation on patient outcomes.