Oesophageal cancer surgery: 10-year experience in a regional Australian hospital.

Abstract

BACKGROUND A meta-analysis by Metzger et al. into patient survival after oesophageal surgery suggests acceptable clinical outcomes could only realistically be achieved in high-volume tertiary hospitals (performing more than twenty surgeries annually). Currently data from regional Australian hospitals which perform oesophageal surgery does not exist in the published literature. The aim of this study was to compare the mortality rates at a very-low-volume regional Australian hospital to those found in the meta-analysis. METHODS A ten-year retrospective audit was performed of patients who underwent oesophageal surgery within the period of 2004-2014 at Ballarat Base Hospital, a regional public hospital in Ballarat, Australia. RESULTS The average number of oesophagectomies performed annually over the ten-year period were less than 5, classified by Metzger as a very-low-volume hospital. 30-day mortality rates post discharge over the ten-year period was 0% with total 30-day mortality rates at 4% (±7.6% 95% CI) due to one in-hospital death. CONCLUSIONS This study showed lower 30-day mortality rates compared to those reported in the meta-analysis from hospitals classified as very-low-volume. This study suggests that a very-low-volume hospital was capable of achieving similar mortality rates of high-volume hospitals from the meta-analysis. Our results cast doubt over the push for oesophageal surgery to be performed only in tertiary centres. The impact of centralisation on quality of life for rural patients must be considered before such a move can be advocated.