Complex cancer surgery carries a significant level of risk. Outcomes require continuous monitoring to ensure cancer patients are accessing a safe and effective service. We evaluated complex cancer surgery outcomes across six tumour streams to assess whether surgical outcomes for Queensland cancer patients improved between 2000 and 2014.
Cancer incidence and surgery data for Queensland cancer patients diagnosed from 2000-2014 were sourced from the Queensland Oncology Repository. Patients receiving the following types of surgery were included in the analysis: rectal, pancreaticoduodenectomy (PD), lung, bladder, oesophagectomy and gastrectomy. Death data was available until 31 December 2016.
Patients were divided into three five-year cohorts based on their date of diagnosis. Surgery was selected on the basis of being the final definitive surgical treatment for a diagnosis. Short-term post-operative mortality was reported at 30 and 90 days, along with in-hospital mortality. Longer term surgical survival at one and two years was also calculated.
30-day mortality rates for the most recent period (2010-2014) ranged from 0.4% for cystectomy surgery to 4.9% for gastrectomy surgery. Surgical survival at one and two years was highest for rectal cancer surgery (93% and 87% respectively) and lowest for gastrectomy surgery with 79% after one year and PD surgery where 63% of patients survived two years.
Short term mortality decreased over the period following PD, cystectomy, lung and rectal surgery. Surgical survival increased most for patients undergoing PD and lung surgery.
Queensland cancer patients experience low rates of short-term post-operative mortality when compared with international data. Improvements in both short and longer term outcomes for cancer patients may reflect changes in patient selection but also in the centralization of surgery for these cancers where volume-outcome associations are known to exist.