• AveryKerry N LKNLCentre for Surgical Research, School of Social and Community Medicine, University of Bristol, United Kingdom., Katy A Chalmers, Sara T Brookes, Natalie S Blencowe, Karen Coulman, Katie Whale, Chris Metcalfe, Jane M Blazeby, ROMIO Study Group, and CONSENSUS Esophageal Cancer Working Group.
• Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, United Kingdom.
• Ann. Surg. 2018 Apr 1; 267 (4): 700710700-710.

ObjectiveDevelopment of a core outcome set (COS) for clinical effectiveness trials in esophageal cancer resection surgery.BackgroundInconsistency and heterogeneity in outcome reporting after esophageal cancer resection surgery hampers comparison of trial results and undermines evidence synthesis. COSs provide an evidence-based approach to these challenges.MethodsA long list of clinical and patient-reported outcomes was identified and categorized into outcome domains. Domains were operationalized into a questionnaire and patients and health professionals rated the importance of items from 1 (not important) to 9 (extremely important) in 2 Delphi survey rounds. Retained items were discussed at a consensus meeting and a final COS proposed. Professionals were surveyed to request endorsement of the COS.ResultsA total of 68 outcome domains were identified and operationalized into a questionnaire; 116 (91%) of consenting patients and 72 (77%) of health professionals completed round 1. Round 2 response rates remained high (87% patients, 93% professionals). Rounds 1 and 2 prioritized 43 and 19 items, respectively. Retained items were discussed at a patient consensus meeting and a final 10-item COS proposed, endorsed by 61/67 (91%) professionals and including: overall survival; in-hospital mortality; inoperability; need for another operation; respiratory complications; conduit necrosis and anastomotic leak; severe nutritional problems; ability to eat/drink; problems with acid indigestion or heartburn; and overall quality of life.ConclusionsThe COS is recommended for all pragmatic clinical effectiveness trials in esophageal cancer resection surgery. Further work is needed to delineate the definitions and parameters and explore best methods for measuring the individual outcomes.

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