title: Early outcomes from the Dutch Upper Gastrointestinal Cancer Audit.
abstract: BACKGROUND
  In 2011, the Dutch Upper Gastrointestinal Cancer Audit (DUCA) group began nationwide registration of all patients undergoing surgery with the intention of resection for oesophageal or gastric cancer. The aim of this study was to describe the initiation and implementation of this process along with an overview of the results.
  
  
  METHODS
  The DUCA is part of the Dutch Institute for Clinical Auditing. The audit provides (surgical) teams with reliable, weekly updated, benchmarked information on process and (case mix-adjusted) outcome measures. To accomplish this, a web-based registration was designed, based on a set of predefined quality measures.
  
  
  RESULTS
  Between 2011 and 2014, a total of 2786 patients with oesophageal cancer and 1887 with gastric cancer were registered. Case ascertainment approached 100 per cent for patients registered in 2013. The percentage of patients with oesophageal cancer starting treatment within 5 weeks of diagnosis increased significantly over time from 32·5 per cent in 2011 to 41·0 per cent in 2014 (P < 0·001). The percentage of patients with a minimum of 15 examined lymph nodes in the resected specimen also increased significantly for both oesophageal cancer (from 50·3 per cent in 2011 to 73·0 per cent in 2014; P < 0·001) and gastric cancer (from 47·5 per cent in 2011 to 73·6 per cent in 2014; P < 0·001). Postoperative mortality remained stable (around 4·0 per cent) for patients with oesophageal cancer, and decreased for patients with gastric cancer (from 8·0 per cent in 2011 to 4·0 per cent in 2014; P = 0·031).
  
  
  CONCLUSIONS
  Nationwide implementation of the DUCA has been successful. The results indicate a positive trend for various process and outcome measures.
authors.affiliation: Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.|Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: L A D
authors.initials: LA
authors.lastname: Busweiler
authors.affiliation: Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: B P L
authors.initials: BP
authors.lastname: Wijnhoven
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: M I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.affiliation: Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.|Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Henneman
authors.affiliation: Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: N C T
authors.initials: NC
authors.lastname: van Grieken
authors.affiliation: Dutch Institute for Clinical Auditing, Leiden University Medical Centre, Leiden, The Netherlands.|Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
authors.affiliation: Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van Hillegersberg
authors.affiliation: Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: van Sandick
authors.affiliation: Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000628:therapy*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000628:therapy*