Early impact of centralization of oesophageal cancer surgery services

Authors: G. Branagan; N. Davies

Source: British Journal of Surgery, Volume 91, Number 12, December 2004 , pp. 1630-1632(3)

Publisher: John Wiley & Sons, Ltd.

Abstract:

Background:

In response to national guidance, oesophageal surgery from four hospitals within Wessex was centralized to a single site, with a provision for surgeons to travel to the centre to operate if they wished. This study assessed the clinical impact of this change.

Methods:

Data for patients who had oesophageal cancer surgery at the single site were collected prospectively for 1 year from May 2002 and compared with the Wessex Oesophageal Cancer Audit (WOCA) data for the four hospitals from 1999 to 2000.

Results:

Thirty-three patients underwent surgery on the single site compared with 40 patients from the four hospitals during the WOCA. Age, sex, co-morbidity, tumour site, and preoperative tumour and node stage were similar in the two groups. Six patients from the WOCA underwent ‘open and close’ laparotomy compared with none in the single-site group (P = 0·020). There were four anastomotic leaks in the WOCA group and two in the single-site group. Overall complication rates in those undergoing resection were similar in the two groups, but the in-hospital mortality rate was significantly higher in the WOCA group (five versus no patients; P = 0·022). Pathology reporting was incomplete in significantly more patients in the WOCA group (15 versus three; P = 0·001). The mean node harvest was greater in the single-site group (30·5 versus 19).

Conclusion:

Centralization of oesophageal surgery resulted in better preoperative staging, a lower 30-day mortality rate and more complete pathological reporting. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Document Type: Research article

DOI: http://dx.doi.org/10.1002/bjs.4753

Affiliations: 1: Department of Surgery, Royal Bournemouth Hospital, Bournemouth, UK

Publication date: 2004-12-01

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