{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T19:01:32Z","timestamp":1766516492416,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Qual Health Care"],"published-print":{"date-parts":[[1993,3]]},"abstract":"<jats:p>OBJECTIVE--To measure the extent of use of, and perioperative mortality from, oesophagectomy for carcinoma of the oesophagus, and to examine the association between oesophagectomy and long term survival. DESIGN--Retrospective cohort study of cases of oesophageal carcinoma notified to the Thames Cancer Registry. SETTING--South East Thames and South West Thames health regions. PATIENTS--3273 patients first registered with carcinoma of the oesophagus during 1985-9, 789 of whom were excluded because of incomplete data, leaving 2484 (75.9%) for further analysis. MAIN MEASURES--Treatment of oesophagectomy, mortality within 30 days of oesophagectomy, and duration of survival from date of diagnosis to death, according to patient and tumour characteristics. RESULTS--Oesophagectomy was performed in 571(23.0%) patients. Its use decreased with increasing age (odds ratio (95% confidence interval) 0.935(0.925 to 0.944) per year) and was less common for tumours of the middle or upper third of the oesophagus than the lower third (0.56(0.42 to 0.75)). The proportion of patients undergoing oesophagectomy varied threefold among the 28 districts of residence. The perioperative mortality rate was 15.1(86\/571) (12% to 18%); it increased with age (odds ratio 1.05(1.02 to 1.08) per year) and for tumours of the middle or upper third of the oesophagus compared with the lower third (2.52(1.31 to 4.84)). Long term survival was slightly higher for patients undergoing oesophagectomy (0.5% v 0.2%). CONCLUSIONS--Despite a high perioperative mortality rate patients selected for oesophagectomy showed better long term survival than those who were not, suggesting that clinical judgements used in selection were independent markers of a better prognosis. The nature of this selection needs to be more completely characterised to permit a valid evaluation of outcome of oesophagectomy.<\/jats:p>","DOI":"10.1136\/qshc.2.1.17","type":"journal-article","created":{"date-parts":[[2008,9,29]],"date-time":"2008-09-29T13:52:26Z","timestamp":1222696346000},"page":"17-20","source":"Crossref","is-referenced-by-count":14,"title":["Selection for oesophagectomy and postoperative outcome in a defined population."],"prefix":"10.1136","volume":"2","author":[{"given":"M C","family":"Gulliford","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J R","family":"Barton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H M","family":"Bourne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1993,3,1]]},"reference":[{"key":"ref_1","article-title":"Quality ofclinical care in National Health Service hospitals","author":"of Commons Public Accounts Committee, House","year":"1988","unstructured":"House of Commons Public Accounts Committee. Quality ofclinical care in National Health Service hospitals. London: HMSO, 1989. (Tenth report: session 1988-9.)"},{"key":"ref_2","article-title":"Population Censuses and Surveys. Mortality statistics: cause, 1989","author":"Office of","year":"1991","unstructured":"Office of Population Censuses and Surveys. Mortality statistics: cause, 1989. London: HMSO, 1991. (Series DH 2, No 16.)"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1002\/bjs.1800670602","article-title":"Oesophageal squamous cell carcinoma. I. A critical review of surgery","volume":"67","author":"Earlam, R.; Cunha-Melo, JR","year":"1980","unstructured":"Earlam R, Cunha-Melo JR. Oesophageal squamous cell carcinoma. I. A critical review of surgery. Br J Surg 1980;67:381-90.","journal-title":"Br J Surg"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1136\/thx.36.12.891","article-title":"Surgical treatment of carcinoma of the oesophagus","volume":"36","author":"Dark, J.F.; Mousalli, H.; Vaughan, R.","year":"1981","unstructured":"Dark JF, Mousalli H, Vaughan R. Surgical treatment of carcinoma of the oesophagus. Thorax 1981;36:891-5.","journal-title":"Thorax"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1136\/bmj.303.6811.1202-a","article-title":"Treating carcinoma of the oesophagus [letter]","volume":"303","author":"Pagliero, K.M.","year":"1991","unstructured":"Pagliero KM. Treating carcinoma of the oesophagus [letter]. BMJ 1991;303:1202.","journal-title":"BMJ"},{"key":"ref_6","series-title":"Brachytherapy 2. Proceedings of the fifth international Selectron users' meeting, 1988","first-page":"449","article-title":"Carcinoma of the oesophagus: treatment of radical surgery or brachytherapy","author":"Kaul, T.K.; Rowland, C.G.; Pagliero, K.M.","year":"1989","unstructured":"Kaul TK, Rowland CG, Pagliero KM. Carcinoma of the oesophagus: treatment of radical surgery or brachytherapy. In: RF Mould, ed. Brachytherapy 2. Proceedings of the fifth international Selectron users' meeting, 1988. Leersum: Nucletron, 1989:449-58"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1002\/bjs.1800750329","article-title":"Treatment policy for the management of carcinoma of the oesophagus","volume":"75","author":"Desa, L.; Raghunath, A.S.; Chawla, S.L.; Peel, A.L.G.; Dellipiani, A.W.","year":"1988","unstructured":"Desa L, Raghunath AS, Chawla SL, Peel ALG, Dellipiani AW. Treatment policy for the management of carcinoma of the oesophagus. Br J Surg 1988;75:275-8.","journal-title":"Br J Surg"},{"key":"ref_8","first-page":"4","article-title":"Squamous cell carcinoma of the oesophagus: 10 years on. Ann R Coil Surg Engl","volume":"73","author":"Khoury, G.A.","year":"1991","unstructured":"Khoury GA. Squamous cell carcinoma of the oesophagus: 10 years on. Ann R Coil Surg Engl 1991;73:4-7."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1136\/gut.32.8.841","article-title":"Palliation of malignant dysphagia: surgery, radiotherapy, laser, intubation alone or in combination?","volume":"32","author":"Bown, S.G.","year":"1991","unstructured":"Bown SG. Palliation of malignant dysphagia: surgery, radiotherapy, laser, intubation alone or in combination? Gut 1991;32:841-4.","journal-title":"Gut"},{"key":"ref_10","first-page":"8","article-title":"An MRC prospective randomised trial of radiotherapy versus surgery for operable squamous cell carcinoma of the oesophagus","volume":"73","author":"Earlam, R.","year":"1991","unstructured":"Earlam R. An MRC prospective randomised trial of radiotherapy versus surgery for operable squamous cell carcinoma of the oesophagus. Ann R Coll Surg Engl 1991;73:8-12.","journal-title":"Ann R Coll Surg Engl"},{"key":"ref_11","article-title":"International classification of diseases for oncology","author":"World Health Organisation","year":"1976","unstructured":"World Health Organisation. International classification of diseases for oncology. 1st ed. Geneva: WHO, 1976.","edition":"1st ed"},{"key":"ref_12","first-page":"269","article-title":"The LOGIST procedure","volume-title":"SAS Users' Group International. SUGI supplemental library users' guide. Version 5,","author":"Harrell, F.E.","year":"1986","unstructured":"Harrell FE. The LOGIST procedure. In: SAS Users' Group International. SUGI supplemental library users' guide. Version 5, ed. Cary, North Carolina: SAS, 1986:269-93."},{"key":"ref_13","first-page":"759","article-title":"BMDP statistical software manual. Vol 2","author":"Dixon, W.J.","year":"1990","unstructured":"Dixon WJ. BMDP statistical software manual. Vol 2. Berkeley, California: University of California Press, 1990:759-806."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"526","DOI":"10.2105\/AJPH.78.5.526","article-title":"Studying patterns of cancer care: how useful is the medical record?","volume":"78","author":"G, Fiegl P.Glaefcke; L, Ford; P, Diehr; J, Chu","year":"1988","unstructured":"Fiegl P. Glaefcke G, Ford L, Diehr P, Chu J. Studying patterns of cancer care: how useful is the medical record? 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BMJ 1984;288:1892-4.","journal-title":"BMJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1002\/bjs.1800730811","article-title":"Effects of surgical experience on the results of resection for oesophageal carcinoma","volume":"73","author":"Matthews, H.R.; Powell, D.J.; McConkey, C.C.","year":"1986","unstructured":"Matthews HR, Powell DJ, McConkey CC. Effects of surgical experience on the results of resection for oesophageal carcinoma. Br J Surg 1986;73:621-3.","journal-title":"Br J Surg"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/0895-4356(88)90132-1","article-title":"Clinical assessments as predictors of one year survival after hospitalisation: implications for prognostic stratification","volume":"41","author":"ME, Pompei P.Charlson; RG, Douglas","year":"1988","unstructured":"Pompei P. Charlson ME, Douglas RG. Clinical assessments as predictors of one year survival after hospitalisation: implications for prognostic stratification. J Clin Epidemiol 1988;41:275-84.","journal-title":"J Clin Epidemiol"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1056\/NEJM198110223051704","article-title":"Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer","volume":"305","author":"McNeil, B.J.; Weichselbaum, R.; Pauker, S.G.","year":"1981","unstructured":"McNeil BJ, Weichselbaum R, Pauker SG. Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer. 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