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Background: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. Method: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%). Results: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17–4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57–1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54–1.32, p = 0.5), compared to HIC. Conclusion: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.
Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study
Kamarajah S. K.;Nepogodiev D.;Bekele A.;Cecconello I.;Evans R. P. T.;Guner A.;Gossage J. A.;Harustiak T.;Hodson J.;Isik A.;Kidane B.;Leon-Takahashi A. M.;Mahendran H. A.;Negoi I.;Okonta K. E.;Rosero G.;Sayyed R. H.;Singh P.;Takeda F. R.;van Hillegersberg R.;Vohra R. S.;White R. E.;Griffiths E. A.;Alderson D.;Bundred J.;Gossage J.;Jefferies B.;McKay S.;Mohamed I.;Siaw- Acheampong K.;Vohra R.;Wanigasooriya K.;Whitehouse T.;Gjata A.;Moreno J. I.;Guevara C. R.;Kechagias A.;Gockel I.;Kennedy A.;Da Roit A.;Bagajevas A.;Azagra J. S.;Mejia-Fernandez L.;Wijnhoven B. P. L.;El Kafsi J.;Sousa M.;Sampaio A. S.;Blanco R.;Wallner B.;Schneider P. M.;Hsu P. K.;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.;Arias- Amezquita 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.;Alghunaim E.;Elhadi M.;Medina-Franco H.;Lau P. C.;Heisterkamp J.;Rosman C.;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.;Bjelovic M.;So J. B. Y.;Gacevski G.;Loureiro C.;Pera M.;Bianchi A.;Moreno G. M.;Martin Fernandez J.;Trugeda Carrera M. S.;Vallve-Bernal M.;Citores Pascual M. A.;Elmahi S.;Halldestam I.;Hedberg J.;Monig S.;Gutknecht S.;Tez M.;Tirnaksiz M. B.;Colak E.;Sevinc 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.;Nijjar R.;Viswanath Y. K. S.;Turner P.;Dexter S.;Boddy A.;Allum W. H.;Oglesby S.;Cheong E.;Beardsmore D.;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.;Sallum R. A. A.;da Rocha J. R. M.;Lopes L. R.;Tercioti V.;Coelho J. D.;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.;Beltran-Garcia T. C.;Castilla L.;Pineda M.;Bastidas A.;Gomez-Mayorga J.;Cortes 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. H.;Koivukangas V.;Merilainen 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.;Mpali E.;Mpoura M.;Charalabopoulos A.;Manatakis D. K.;Balalis D.;Bolger J.;Baban C.;Mastrosimone A.;McAnena O.;Quinn A.;O Suilleabhain C. B.;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.;Tan Y. R.;Thannimalai S.;Ho C. A.;Pang W. S.;Tan J. H.;Basave H. N. L.;Cortes-Gonzalez 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 Sluis P. C.;de Maat M.;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.;Bernardes A.;Campos J. C.;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.;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.;Gunjic D.;Veselinovic M.;Babic T.;Chin T. S.;Shabbir A.;Kim G.;Crnjac A.;Samo H.;Diez del Val I.;Leturio S.;Ramon J. M.;Dal Cero M.;Rifa 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.;Garcia S. S.;Santos E. P. G.;Martinez E. T.;Fernandez D. M.;Magadan A. C.;Concepcion M. V.;Diaz L. C.;Rosat R. A.;Perez S. L.;Bailon C. M.;Tinoco C. C.;Choolani Bhojwani E.;Sanchez D. P.;Ahmed M. E.;Dzhendov T.;Lindberg F.;Rutegard 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.;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 L. 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.;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.;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.
2021
Abstract
Background: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. Method: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%). Results: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17–4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57–1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54–1.32, p = 0.5), compared to HIC. Conclusion: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/3377924
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
