Early impact of centralization of oesophageal cancer surgery services

BACKGROUND: In response to national guidance, oesophageal surgery from four hospitals within Wessex was centralized to a single site, with a provision for surgeons to travel to the centre to operate if they wished. This study assessed the clinical impact of this change. METHODS: Data for patients who had oesophageal cancer surgery at the single site were collected prospectively for 1 year from May 2002 and compared with the Wessex Oesophageal Cancer Audit (WOCA) data for the four hospitals from 1999 to 2000. RESULTS: Thirty-three patients underwent surgery on the single site compared with 40 patients from the four hospitals during the WOCA. Age, sex, co-morbidity, tumour site, and preoperative tumour and node stage were similar in the two groups. Six patients from the WOCA underwent 'open and close' laparotomy compared with none in the single-site group (P = 0.020). There were four anastomotic leaks in the WOCA group and two in the single-site group. Overall complication rates in those undergoing resection were similar in the two groups, but the in-hospital mortality rate was significantly higher in the WOCA group (five versus no patients; P = 0.022). Pathology reporting was incomplete in significantly more patients in the WOCA group (15 versus three; P = 0.001). The mean node harvest was greater in the single-site group (30.5 versus 19). CONCLUSION: Centralization of oesophageal surgery resulted in better preoperative staging, a lower 30-day mortality rate and more complete pathological reporting.