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 monsoonal winds on chlorophyll-<i>α</i> distribution in the Beibu Gulf - Fig 1

<p><b>A: Map of the region of interest, with detailed study region shown by the expanded box. B: The bathymetric chart of the in situ and satellite data sampling area (The base maps of A and B were produced by ARCGIS 10).</b> The in-situ sampling stations are denoted by dots, and the three transects T1, T2 and T3 are indicated by lines. The path of T1 covers areas with water depth less than 40 m, T2 with water depth less than 60 m, and T3 with water depth greater than 70 m at the mouth of the Beibu Gulf.</p

Monthly-averaged chl-<i>a</i> (mg m^-3) and SST (°C) during the field survey cruises in the Beibu Gulf.

<p>Red arrows in A1 and A2 show a patch of high chl-<i>a</i> concentration increasing towards the southwest. Red arrows in B1 and B2 show that low SST is detected in the same region of high chl-<i>a</i> during the northeast monsoon. Red circles in B3 and B4 show that the water temperature in this region was influenced by the Red River discharge in spring and summer. The black arrow in B4 shows a low SST region southwest of Hainan Island in summer.</p

Comparison between CATSAT-derived and in-situ measurements of water temperature.

<p>Comparison between CATSAT-derived and in-situ measurements of water temperature.</p

Spatial distribution of monthly-averaged MLD during four seasons from 2002 to 2014 in Beibu Gulf.

<p>Spatial distribution of monthly-averaged MLD during four seasons from 2002 to 2014 in Beibu Gulf.</p

Scatter plot of monthly chl-<i>a</i> vs. monthly wind speed from 2002 to 2014 averaged over the Beibu Gulf (105°40′-110°E, 17°-22°N).

<p>Scatter plot of monthly chl-<i>a</i> vs. monthly wind speed from 2002 to 2014 averaged over the Beibu Gulf (105°40′-110°E, 17°-22°N).</p

Climatological monthly averaged wind velocity in the Beibu Gulf during July 2002—December 2014.

<p>The arrow indicates wind direction, with the northward being upwards.</p

Comparison between MODIS-derived and in situ measurements of chl-<i>a</i> in the Beibu Gulf.

<p>Comparison between MODIS-derived and in situ measurements of chl-<i>a</i> in the Beibu Gulf.</p