Perioperative complications influence long- and short-term outcomes after esophagectomy. The absence of a standardized system for defining and recording complications and quality measures after esophageal resection has meant that there is wide variation in evaluating their impact on these outcomes.
The Esophageal Complications Consensus Group comprised 21 high-volume esophageal surgeons from 14 countries, supported by all the major thoracic and upper gastrointestinal professional societies. Delphi surveys and group meetings were used to achieve a consensus on standardized methods for defining complications and quality measures that could be collected in institutional databases and national audits.
A standardized list of complications was created to provide a template for recording individual complications associated with esophagectomy. Where possible, these were linked to preexisting international definitions. A Delphi survey facilitated production of specific definitions for anastomotic leak, conduit necrosis, chyle leak, and recurrent nerve palsy. An additional Delphi survey documented consensus regarding critical quality parameters recommended for routine inclusion in databases. These quality parameters were documentation on mortality, comorbidities, completeness of data collection, blood transfusion, grading of complication severity, changes in level of care, discharge location, and readmission rates.
The proposed system for defining and recording perioperative complications associated with esophagectomy provides an infrastructure to standardize international data collection and facilitate future comparative studies and quality improvement projects.
Complications affect every major outcome parameter after major cancer surgery. No internationally accepted system for documenting complications after esophagectomy currently exists. Using the Delphi process, high-volume esophageal surgeons from 14 countries have reached a consensus on a standardized list of complications, quality measures, and definitions for specific complications.
*Virginia Mason Medical Center, Seattle, WA
†University of Birmingham, Birmingham, United Kingdom
‡University of São Paulo, School of Medicine, São Paulo, Brazil
§University of Michigan Health System, Ann Arbor, MI
¶Toronto General Hospital, Toronto, Ontario, Canada
‖Sainte Marguerite Hospital, Marseille, France
**University of Newcastle upon Tyne, Newcastle, United Kingdom
††University of Cologne, Cologne, Germany
‡‡MD Anderson Cancer Center, Houston, TX
§§Allegheny Health Network's Esophageal and Thoracic Institute, Pittsburgh, PA
¶¶Keio University, Tokyo, Japan
‖‖University of Pennsylvania, Philadelphia, PA
***Queen Mary Hospital, Hong Kong SAR, China
†††Katholieke Universiteit Leuven, Leuven, Belgium
‡‡‡Oxford Radcliffe Hospitals, Oxford, United Kingdom
§§§Hospital Universitario del Mar, Barcelona, Spain
¶¶¶University of Rochester Surgery, Rochester, NY
‖‖‖Tata Hospital, Mumbai, India
****Trinity College Dublin, Dublin, Ireland
††††Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
‡‡‡‡Erasmus Medical Center, Rotterdam, The Netherlands.
Reprints: Donald E. Low, FACS, FRCS(C), FRCSI (Hon.), Section of General Thoracic Surgery, Virginia Mason Medical Center, 1100 Ninth Ave, C6-SUR, Seattle, WA 98111. E-mail: firstname.lastname@example.org.
Disclosure: The authors received no formal funding for this project, although a benefactor “The Hayward Family Foundation” donated funds for esophageal cancer research to the Virginia Mason Medical Center Foundation. This donation was used to support the 4 meetings of the Esophageal Complications Consensus Group (ECCG). The authors declare no conflicts of interest.