Background: Quality markers in oesophago-gastric cancer surgery are not widely agreed upon and benchmarking performance is difficult.
Methods: We compared data from the UK oesopahgo-gastric cancer audit (http://www.hscic.gov.uk/og) to the prospectively maintained Alfred hospital oesopahgo-gastric cancer database across quality domains.
Results: One hundred and ninety two Alfred and 17,279 UK audit patients were identified. Demographics were similar. Case ascertainment was 76.8% vs. 71.1%, (p<0.11). The Alfred was in the second highest quintile by volume (154 Trusts).
More Alfred patients had staging with CT (100% vs. 89%, p<0.01), PET (89.1% vs. 78%, p<0.01). and laparoscopy (80.9% vs 49%, p<0.01).
A higher proportion of patients embarked on a curative treatment pathway (53% vs. 35.9% (p<0.001)).
Neo-adjuvant therapy for oesophagectomies: 94.4% vs. 97.2% (p<0.32), gastrectomies: 79.2% vs. 93.1% (p<0.002).
Acceptable lymph node yields were: oesophagectomies: 96.2% vs. 77.5%, (p<0.01) and gastrectomies: 74.6% vs. 58.5%, (p<0.01).
Peri-operative mortality for oesophagectomies: 4.1% vs 4.5% (p<1.0), gastrectomies; 4.6% vs. 6.0% (p<0.90). Anastomotic leaks oesophagectomy: 16.3% vs.8.3% (p<0.10), gastrectomy: 6.2% vs. 5.9% (p<1.0).
Survival at one and three years, oesophagectomies: (78.2% vs 73.6%), (46.4% vs 43.5%) and gastrectomies: (77.6% vs 75.2%), (49.4% vs. 42.1%), (p<0.74).
Response rate to EORTC quality of life instrument: 71.4% vs. 22% (p<0.01).
Conclusions: In Alfred patients, more staging and curative treatment pathways, less use of neo-adjuvant therapy in gastric cancer, lower lymph node yields, equivalent survival and better follow up of quality of life were identified with similar demographics and case ascertainment. Measuring a range of quality domains is essential to identify deficiencies and optimise performance