Failure to rescue patients from early critical complications of oesophagogastric cancer surgery

• Major oesophagogastric surgery has inherent risks and complications.
• In- hospital mortality involves patient, tumour, and surgeon-related factors.
• Failure to rescue and not complication rate is the significant cause of in-hospital mortality.
• Early non-operative or re-operative intervention is the key.
• Improved multidisciplinary approach would decrease in-hospital mortality.

‘Failure to rescue’ is a significant cause of mortality in gastrointestinal surgery. Differences in mortality between high and low-volume hospitals are not associated with large difference in complication rates but to the ability of the hospital to effectively rescue patients from the complications. We reviewed the critical complications following surgery for oesophageal and gastric cancer, their prevention and reasons for failure to rescue. Strategies focussing on perioperative optimization, the timely recognition and management of complications may be essential to improving outcome in low-volume hospitals.