Oesophagectomy and total gastrectomy in a specialized district general hospital unit

Abstract Background: The aim was to demonstrate that a low operative mortality rate (less than 5 per cent) is achievable for both oesophagectomy and total gastrectomy (TG) in a medium‐sized district general hospital (DGH). Methods: This was a prospective audit of all oesophagectomies and TGs performed in the first 5 years after establishment of a specialized upper gastrointestinal surgical–anaesthetic team. Results: Some 82 procedures were undertaken, all by the same surgical team. Forty patients (median age 66 (range 41–76) years) underwent subtotal oesophagectomy (STO) using the two‐stage approach. Forty‐two patients (median age 68 (range 35–80) years) underwent TG using a left thoracoabdominal approach in four and an abdominal approach in 38. There were no deaths in hospital or within 30 days for either procedure. Two patients in each group died within 90 days: one from myocardial infarction and one from paraneoplastic syndrome after STO; one from pulmonary embolism and one from malignant adhesive obstruction after TG. There was one anastomotic leak in each group. Four patients required a second procedure: for a postoperative bleed, a thoracic duct leak and a feeding jejunostomy (one patient each) after STO; and for drainage of a left subphrenic abscess after TG. Conclusion: It is reasonable to aim for an operative mortality rate of under 5 per cent for both STO and TG even in a DGH treating relatively small numbers of patients. Preoperative assessment and peroperative management by a single surgical–anaesthetic team, use of epidural analgesia and treatment in dedicated ward areas are all contributory factors. Clinical, audit and research links to the Northern Oesophago‐Gastric Cancer Unit in Newcastle have ensured a uniformity of care across the region. © 1999 British Journal of Surgery Society Ltd