P1.200. Reducing Failure to Rescue Improves Long Term Survival After Oesophago-Gastric Cancer Surgery

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Outcomes after oesophago-gastric cancer surgery have improved over time, and this is likely to be multifactorial. In addition to better oncologic treatments, safer surgery should reduce complications, whereas safer peri-operative care should reduce deaths once complications occur. We examined which of the latter two mechanisms explained survival improvement over 24 years of practice. All patients undergoing curative-intent oesophagectomy or gastrectomy for malignancy between 2001 and 2025 in a specialist UK unit were studied. Major complications were defined as Clavien–Dindo grade ≥3. Failure-to-rescue (FTR) was defined as in-hospital death following a major complication. Temporal trends in complication rate, in-hospital mortality and FTR were assessed. Overall survival was analysed using multivariable Cox regression adjusting for age, sex, co-morbidity, procedure type and pathological stage. Among 1,763 resections with complete complication and mortality data (73.7% male, median age 69 years, median length of stay 13 days; 71.6% oesophagectomy, 26.1% gastrectomy), major complications occurred in 18.4% and in-hospital mortality was 5.9%. Complication rates remained broadly stable over time, whereas in-hospital mortality declined. This corresponded with a marked reduction in FTR from approximately 40–50% in earlier years to 12–20% in later years. Among patients discharged alive, adjusted long-term survival did not differ between those with and without major complications (HR 0.90, 95% CI 0.75–1.07; p=0.22). Temporal improvements in survival therefore paralleled improved rescue rather than reduced complication incidence. Improved outcomes after oesophago-gastric cancer surgery were associated with reduced in-hospital death following complications and translated into improved long-term survival. These findings suggest survival gains relate more to recognition and management of complications than to further reductions in complication rates alone.