Objective

Thoracic surgeons in the United Kingdom are now infrequently involved in the treatment of patients with oesophageal cancer. However, thoracic surgeons are still needed to address specific complications, sometimes in an emergency setting. We wished to identify these cases from our joint Upper GI oesophageal practice.

Methods

Retrospective case note review of identified patients in a prospectively collected database. A total of 294 oesophagectomies have been performed at our institution from 2011 onwards; 132 (45%) by thoracic surgeons and 162 (55%) by Upper GI surgeons. Of the oesophagectomies not performed by ourselves there were 7/162 patients (4%) who needed direct thoracic surgical involvement. All 7 oesophagectomies were performed for cancer; 4 distal and 3 mid-oesophageal, 6 Ivor-Lewis and 1 McKeown.

Results

There were a total of 11 major thoracic complications in this cohort (N=162); 2 haemorrhages, 2 prolonged airleaks, 3 fistulas (2 broncho-pleural, 1 broncho-gastric), 3 empyemas, and 1 airway compression. There were 12 procedures performed by thoracic surgeons in these patients; 3 diagnostic bronchoscopies, 2 tracheo-bronchial stents, 1 emergency lobectomy, 1 control of bleeding, 2 decortications, 1 Clagget window, and 2 bronchial repairs. There was one inpatient death in this cohort (14%).

Conclusion

The potential mortality for patients with a thoracic complication post-oesophagectomy is high and joint Upper GI – Thoracic oesophageal units can help improve outcomes. This should be taken into consideration in the design of cancer networks as well as for the training of future thoracic surgeons.