Postoperative outcomes in oesophagectomy with trainee involvement

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

Interference between healthy and rusted groundsel (Senecio-Vulgaris L) within mixed populations of different densities and proportions

Plants of groundsel (Senecio vulgaris L.), either inoculated with rust Puccinia lagenophorae Cooke or uninoculated, were grown to capitulum production at a range of densities up to 2240 plants m−2, both in monoculture and together in mixture. Rust infection reduced vegetative growth and capitulum production in monocultures and mixtures. However, in mixture, unequal interference between inoculated and uninoculated plants amplified the effect of rust infection on growth. The relative crowding coefficient of uninoculated over rusted groundsel consistently exceeded unity but showed no clear trend in response to planting density. Rust infection resulted in bimodal frequency distributions of plant height, particularly in mixture, i.e. many rusted plants were stunted and were confined to the lowest layers of the shoot canopy. Thus, the reduced yield of the inoculated component of mixtures resulted from the very severe inhibition of growth of a proportion of rusted plants. However, it appeared that suppressed, rusted plants remained able to respond to limitation of available resources since both dry weight partitioning to the roots and specific leaf area increased. Perhaps because of the ability of groundsel to adapt to unfavourable environmental conditions, rust infection resulted in little mortality. Thus, even heavily rusted suppressed plants were able to produce some capitula and, potentially, seed