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

Influence of number of activating KIRs on Disease Free Survival: none vs. one vs. two activating KIRs.

<p>Patients who have two activating KIRs in their genotype have longer DFS compared to those who have one activating KIR. Patients who lack any activating KIR have the shortest DFS: no KIR: 54 months (CI: 42–65); one KIR: 77 months (CI: 61–92); two KIRs: 98 months (CI: 87–108) (p = 0.004). X axis shows percentage of survivors without recurrence against months of follow-up (y axis).</p

Comparison of KIR and KIR ligand genotype frequencies between patients recurring vs. those who did not.

<p>*: Combination of Group C and any cognate inhibitory KIR</p><p>Comparison of KIR and KIR ligand genotype frequencies between patients recurring vs. those who did not.</p

Characteristics of patients.

<p>n.s.: non significant</p><p>Characteristics of patients.</p

Comparison of KIR/Ligand frequencies: local recurrence versus distant metastasis.

<p>The variables found significant after comparison of frequencies between recurrent vs. non-recurrent cases were used in this table.</p

Impact of inhibitory (2DL1, 2DL1-Group C2 and 2DL3 Group C1) (upper row) and activating (2DS2, 2DS2- Group C1 and 2DS3) (lower row) KIRs on Progression Free Survival.

<p>X axis shows percentage of survivors without recurrence against months of follow-up (y axis). The lack of inhibitory KIR2DL1, 2DL1-C2, or 2DL3-C1 improved DFS (100% vs. 62.3%, p = 0.05; 93.8% vs. 60.0%, p = 0.035; 73.6% vs. 55.9%, p = 0.07). Presence of activating KIR2DS2, 2DS2-C1 and 2DS3 (77.8% vs. 48.5%, p = 0.01; 76.9% vs. 51.4%, p = 0.023; 79.4% vs. 58.5%, p = 0.003;) are also associated with longer DFS.</p