Introduction
Oesophagectomy is a key component of the care of patients with oesophageal cancer who are candidates for curative treatment but is associated with substantial morbidity. Centralisation of oesophageal resections has not occurred in Australia, likely due to geographic barriers and limited resources. Therefore, many regional centres perform oesophagectomies.
Methods
Patients who underwent oesophagectomies at Launceston General Hospital from January 2014 to December 2023 were retrospectively identified. Preoperative patient and tumour characteristics, primary outcomes (mortality, anastomotic leak, and length of stay) and secondary outcomes (cardiorespiratory complications, chyle leak, disease recurrence, long-term complications and survival) were assessed and compared to outcomes from higher volume tertiary Australian centres.
Results
65 patients were identified. 53% of patients were male, average age at time operation was 65.2 years, 29.2% had respiratory disease and 18.5% were current smokers. The anastomotic leak rate was 7.7% and 25% of patients developed pneumonia postoperatively. Average ICU length of stay was 4.6 days and median acute inpatient length of stay was 15 days. There was one in-hospital mortality and one 30-day mortality. 3% of patients required surgery subsequently for repair of diaphragmatic hernia and 18.5% required endoscopic dilatation of anastomotic stricture. 5-year survival was 59.5%. Our results compare well to national and international anastomotic leak rates (5-15%), inpatient stay, pneumonia (30%), 30-day mortality (1-4%) and anastomotic stricture rates (20%).
Conclusions
Oesophagectomies can be safely performed in regional centres that routinely undertake a higher volume of cases per year, provided that services in place to manage complications are readily available.