title: Improved short term surgical outcomes in Scotland for oesophageal cancer.
abstract: OBJECTIVE
  This study examined the trends in mortality and contributing adverse events associated with death under surgical care for patients with oesophageal cancer.
  
  
  METHODS
  Adverse events in surgical care were prospectively audited in patients who died with cancer of the oesophagus or oesophago-gastric junction under surgical care in Scotland from 1994 to 2005 through the Scottish Audit of Surgical Mortality (SASM).
  
  
  RESULTS
  Between 1994 and 2005 (inclusive), 1424 patients with oesophageal cancer (median age 72, 62% male) died. The proportion of oesophageal cancer patients dying on a surgical ward fell significantly from 17% to 13% (p = 0.005). There has been a significant decrease in the annual number of major surgical resections for oesophageal cancer in Scotland from 324 in 1994 to 193 in 2005 (p < 0.001). The proportion of patients operated on in specialist cancer centres increased since 2000. In the period 1996 to 2005, 1157 patients died under surgical care with oesophageal cancer and were audited by SASM. One hundred and thirty five patients (12%) had 239 adverse events. Overall, the number of adverse events decreased over time with 65/130 of those who died following a cancer resection had adverse events. An anastomotic leak was a factor in 25 of these patients. There was a significant decrease in the proportion of deaths following therapeutic endoscopy (p = 0.011).
  
  
  CONCLUSIONS
  There has been a significant decrease in the number of cancer resections, adverse events and mortality associated with oesophageal cancer surgery at a time of increasing surgical specialisation.
authors.affiliation: Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. jamie.young@nhs.net
authors.forename: J A
authors.initials: JA
authors.lastname: Young
authors.forename: S M
authors.initials: SM
authors.lastname: Shimi
authors.forename: L
authors.initials: L
authors.lastname: Waugh
authors.forename: G
authors.initials: G
authors.lastname: McPhillips
authors.forename: A M
authors.initials: AM
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D011446:Prospective Studies; D012107:Research Design; D012606:Scotland / Q000453:epidemiology; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data