258. SHORT-TERM OUTCOMES AFTER ESOPHAGECTOMY ANALYZED USING NATIONAL CLINICAL DATABASE IN JAPAN

Abstract Esophagectomy for esophageal cancer is a highly invasive procedure in gastrointestinal surgery. The National Clinical Database (NCD) of Japan starting data collection in 2011 has accumulated real world data of esophagectomy, one of the main nine gastroenterological surgeries for which detailed input items have been required for the evaluation of surgical mortality and postoperative complications. We herein reviewed the short-term outcomes after esophagectomy analyzed by Japanese nationwide big database. Many studies on esophagectomy, including investigations of quality indicators, feasibility of minimally invasive surgery, and various patients’ conditions, have been conducted using NCD. The validation of certification systems by the Japanese Society of Gastroenterological Surgery (JSGS) and the Japan Esophageal Society (JES) revealed that the institute’s certification had greater influence on short-term surgical outcomes than the operating surgeon’s certification. Minimally invasive esophagectomy (MIE) can replace open esophagectomy (OE). MIE performed with no preoperative treatment was associated with significantly less incidence of any pulmonary morbidities, prolonged ventilation 48hours, unplanned intubation, surgical site infection, and sepsis. The total surgery-related mortality rates of MIE and OE were 1.7% and 2.4%, respectively (P < 0.001). The operative mortality in the elderly group with residual tumors increased to more than twice than that in the non-elderly groups (15.9 vs. 5.5 or 6.5%) and was much higher than that in elderly patients without residual tumors (15.9 vs. 4.6%). Careful selection is important for the treatment of elderly patients with highly advanced tumors to avoid unfavorable short-term outcomes. Thus, the NCD has contributed to quality assessment and improvement of surgery by feedback of accurate data in Japan.