Postoperative outcomes in oesophagectomy with trainee involvement
Authors:   Oesophago-Gastric Anastomosis Study Group (OGAA) on behalf of the West Midlands Research Collaborative, Evans R P T , Kamarajah S K , Bundred J , Nepogodiev D , Hodson J , van Hillegersberg R , Gossage J , Vohra R , Griffiths E A , Singh P , Evans R P T , Hodson J , Kamarajah S K , Griffiths E A , Singh P , Alderson D , Bundred J , Evans R P T , Gossage J , Griffiths E A , Jefferies B , Kamarajah S K , McKay S , Mohamed I , Nepogodiev D , Siaw- Acheampong K , Singh P , van Hillegersberg R , Vohra R , Wanigasooriya K , Whitehouse T , Gjata A , Moreno J I , Takeda F R , Kidane B , Guevara Castro R , Harustiak T , Bekele A , Kechagias A , Gockel I , Kennedy A , Da Roit A , Bagajevas A , Azagra J S , Mahendran H A , Mejía-Fernández L , Wijnhoven B P L , El Kafsi J , Sayyed R H , Sousa M , Sampaio A S , Negoi I , Blanco R , Wallner B , Schneider P M , Hsu P K , Isik A , Gananadha S , Wills V , Devadas M , Duong C , Talbot M , Hii M W , Jacobs R , Andreollo N A , Johnston B , Darling G , Isaza-Restrepo A , Rosero G , Arias-Amézquita F , Raptis D , Gaedcke J , Reim D , Izbicki J , Egberts J H , Dikinis S , Kjaer D W , Larsen M H , Achiam M P , Saarnio J , Theodorou D , Liakakos T , Korkolis D P , Robb W B , Collins C , Murphy T , Reynolds J , Tonini V , Migliore M , Bonavina L , Valmasoni M , Bardini R , Weindelmayer J , Terashima M , White R E , Alghunaim E , Elhadi M , Leon-Takahashi A M , Medina-Franco H , Lau P C , Okonta K E , Heisterkamp J , Rosman C , van Hillegersberg R , Beban G , Babor R , Gordon A , Rossaak J I , Pal K M I , Qureshi A U , Naqi S A , Syed A A , Barbosa J , Vicente C S , Leite J , Freire J , Casaca R , Costa R C T , Scurtu R R , Mogoanta S S , Bolca C , Constantinoiu S , Sekhniaidze D , Bjelović M , So J B Y , Gačevski G , Loureiro C , Pera M , Bianchi A , Moreno Gijón M , Martín Fernández J , Trugeda Carrera M S , Vallve-Bernal M , Cítores Pascual M A , Elmahi S , Hedberg J , Mönig S , Gutknecht S , Tez M , Guner A , Tirnaksiz T B , Colak E , Sevinç B , Hindmarsh A , Khan I , Khoo D , Byrom R , Gokhale J , Wilkerson P , Jain P , Chan D , Robertson K , Iftikhar S , Skipworth R , Forshaw M , Higgs S , Gossage J , Nijjar R , Viswanath Y K S , Turner P , Dexter S , Boddy A , Allum W H , Oglesby S , Cheong E , Beardsmore D , Vohra R , Maynard N , Berrisford R , Mercer S , Puig S , Melhado R , Kelty C , Underwood T , Dawas K , Lewis W , Al-Bahrani A , Bryce G , Thomas M , Arndt A T , Palazzo F , Meguid R A , Fergusson J , Beenen E , Mosse C , Salim J , Cheah S , Wright T , Cerdeira M P , McQuillan P , Richardson M , Liem H , Spillane J , Yacob M , Albadawi F , Thorpe T , Dingle A , Cabalag C , Loi K , Fisher O M , Ward S , Read M , Johnson M , Bassari R , Bui H , Cecconello I , Sallum R A A , da Rocha J R M , Lopes L R , Tercioti V , Coelho J D S , Ferrer J A P , Buduhan G , Tan L , Srinathan S , Shea P , Yeung J , Allison F , Carroll P , Vargas-Barato F , Gonzalez F , Ortega J , Nino-Torres L , Beltrán-García T C , Castilla L , Pineda M , Bastidas A , Gómez-Mayorga J , Cortés N , Cetares C , Caceres S , Duarte S , Pazdro A , Snajdauf M , Faltova H , Sevcikova M , Mortensen P B , Katballe N , Ingemann T , Morten B , Kruhlikava I , Ainswort A P , Stilling N M , Eckardt J , Holm J , Thorsteinsson M , Siemsen M , Brandt B , Nega B , Teferra E , Tizazu A , Kauppila J S , Koivukangas V , Meriläinen S , Gruetzmann R , Krautz C , Weber G , Golcher H , Emons G , Azizian A , Ebeling M , Niebisch S , Kreuser N , Albanese G , Hesse J , Volovnik L , Boecher U , Reeh M , Triantafyllou S , Schizas D , Michalinos A , Baili E , Mpoura M , Charalabopoulos A , Manatakis D K , Balalis D , Bolger J , Baban C , Mastrosimone A , McAnena O , Quinn A , Súilleabháin C B Ó , Hennessy M M , Ivanovski I , Khizer H , Ravi N , Donlon N , Cervellera M , Vaccari S , Bianchini S , Sartarelli L , Asti E , Bernardi D , Merigliano S , Provenzano L , Scarpa M , Saadeh L , Salmaso B , De Manzoni G , Giacopuzzi S , La Mendola R , De Pasqual C A , Tsubosa Y , Niihara M , Irino T , Makuuchi R , Ishii K , Mwachiro M , Fekadu A , Odera A , Mwachiro E , AlShehab D , Ahmed H A , Shebani A O , Elhadi A , Elnagar F A , Elnagar H F , Makkai-Popa S T , Wong L F , Yunrong T , Thanninalai S , Aik H C , Soon P W , Huei T J , Basave H N L , Cortés-González R , Lagarde S M , van Lanschot J J B , Cords C , Jansen W A , Martijnse I , Matthijsen R , Bouwense S , Klarenbeek B , Verstegen M , van Workum F , Ruurda J P , van der Veen A , van den Berg J W , Evenett N , Johnston P , Patel R , MacCormick A , Young M , Smith B , Ekwunife C , Memon A H , Shaikh K , Wajid A , Khalil N , Haris M , Mirza Z U , Qudus S B A , Sarwar M Z , Shehzadi A , Raza A , Jhanzaib M H , Farmanali J , Zakir Z , Shakeel O , Nasir I , Khattak S , Baig M , Noor M A , Ahmed H H , Naeem A , Pinho A C , da Silva R , Matos H , Braga T , Monteiro C , Ramos P , Cabral F , Gomes M P , Martins P C , Correia A M , Videira J F , Ciuce C , Drasovean R , Apostu R , Ciuce C , Paitici S , Racu A E , Obleaga C V , Beuran M , Stoica B , Ciubotaru C , Negoita V , Cordos I , Birla R D , Predescu D , Hoara P A , Tomsa R , Shneider V , Agasiev M , Ganjara I , Gunjić D , Veselinović M , Babič T , Chin T S , Shabbir A , Kim G , Crnjac A , Samo H , Díez del Val I , Leturio S , Díez del Val I , Leturio S , Ramón J M , Dal Cero M , Rifá S , Rico M , Pagan Pomar A , Martinez Corcoles J A , Rodicio Miravalles J L , Pais S A , Turienzo S A , Alvarez L S , Campos P V , Rendo A G , García S S , Santos E P G , Martínez E T , Fernández Díaz M J , Magadán Álvarez C , Concepción Martín V , Díaz López C , Rosat Rodrigo A , Pérez Sánchez L E , Bailón Cuadrado M , Tinoco Carrasco C , Choolani Bhojwani E , Sánchez D P , Ahmed M E , Dzhendov T , Lindberg F , Rutegård M , Sundbom M , Mickael C , Colucci N , Schnider A , Er S , Kurnaz E , Turkyilmaz S , Turkyilmaz A , Yildirim R , Baki B E , Akkapulu N , Karahan O , Damburaci N , Hardwick R , Safranek P , Sujendran V , Bennett J , Afzal Z , Shrotri M , Chan B , Exarchou K , Gilbert T , Amalesh T , Mukherjee D , Mukherjee S , Wiggins T H , Kennedy R , McCain S , Harris A , Dobson G , Davies N , Wilson I , Mayo D , Bennett D , Young R , Manby P , Blencowe N , Schiller M , Byrne B , Mitton D , Wong V , Elshaer A , Cowen M , Menon V , Tan L C , McLaughlin E , Koshy R , Sharp C , Brewer H , Das N , Cox M , Al Khyatt W , Worku D , Iqbal R , Walls L , McGregor R , Fullarton G , Macdonald A , MacKay C , Craig C , Dwerryhouse S , Hornby S , Jaunoo S , Wadley M , Baker C , Saad M , Kelly M , Davies A , Di Maggio F , McKay S , Mistry P , Singhal R , Tucker O , Kapoulas S , Powell-Brett S , Davis P , Bromley G , Watson L , Verma R , Ward J , Shetty V , Ball C , Pursnani K , Sarela A , Sue Ling H , Mehta S , Hayden J , To N , Palser T , Hunter D , Supramaniam K , Butt Z , Ahmed A , Kumar S , Chaudry A , Moussa O , Kordzadeh A , Lorenzi B , Wilson M , Patil P , Noaman I , Willem J , Bouras G , Evans R , Singh M , Warrilow H , Ahmad A , Tewari N , Yanni F , Couch J , Theophilidou E , Reilly J J , Singh P , van Boxel G , Akbari K , Zanotti D , Sgromo B , Sanders G , Wheatley T , Ariyarathenam A , Reece-Smith A , Humphreys L , Choh C , Carter N , Knight B , Pucher P , Athanasiou A , Mohamed I , Tan B , Abdulrahman M , Vickers J , Akhtar K , Chaparala R , Brown R , Alasmar M M A , Ackroyd R , Patel K , Tamhankar A , Wyman A , Walker R , Grace B , Abbassi N , Slim N , Ioannidi L , Blackshaw G , Havard T , Escofet X , Powell A , Owera A , Rashid F , Jambulingam P , Padickakudi J , Ben-Younes H , McCormack K , Makey I A , Karush M K , Seder C W , Liptay M J , Chmielewski G , Rosato E L , Berger A C , Zheng R , Okolo E , Singh A , Scott C D , Weyant M J , Mitchell J D 
Published: November 2021

Background

The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting.

Methods

Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups.

Results

Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005).

Conclusion

Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.