Hospital and Surgeon Volume in Relation to Survival After Esophageal Cancer Surgery in a Population-Based Study

Derogar, Maryam; Sadr–Azodi, Omid; Johar, Asif; Lagergren, Pernilla; Lagergren, Jesper

doi:10.1200/jco.2012.46.1517

Cited by 134 publications

(125 citation statements)

References 176 publications

(189 reference statements)

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“…These observations are in line with those of other studies involving oncologic surgery, in which long-term results significantly improved with greater surgeon experience. [24][25][26][27] Moreover, these results are consistent with the primary hypothesis of this study that, whereas the immediate and perhaps midterm outcomes are equally influenced by individual experiences of surgeons during hepatectomy and graft implantation, the long-term outcomes are affected mostly by the experiences of surgeons performing graft implantation. Interestingly, the positive effects of greater experience of the surgeon performing graft implantation were observed only for conventional and not for piggyback liver transplant procedures.…”

Section: Discussionsupporting

confidence: 89%

Untitled

Grąt

Lewandowski²,

Patkowski³

et al. 2018

Exp Clin Transplant

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Objectives: Data on the relevance of surgeon experience in liver transplant procedures are scarce. In this study, we evaluated the effects of individual surgeon experience on survival outcomes after deceased-donor liver transplant. Materials and Methods:In this retrospective analysis of 1193 liver transplant procedures, quantile regression for survival data was performed to assess the effects of surgeon experience. Conditional quantiles of mortality and graft loss were set as primary and secondary outcome measures, respectively, which were categorized as early, midterm, and late. Results: Greater experience of a surgeon performing hepatectomy increased the risk of early mortality (P = .005) and graft loss (P = .025) when the recipient Model for End-Stage Liver Disease was ≤ 25 and the donor Model for End-Stage Liver Disease was ≤ 1600. In conventional transplant procedures, greater experience of surgeon performing hepatectomy additionally increased the risk of midterm mortality (P = .027) and graft loss (P = .046). Conversely, a graft implant procedure performed by a more experienced surgeon was associated with better early, midterm, and late outcomes after conventional transplants (all P < .037) and reduced the risk of early graft loss when the donor Model for End-Stage Liver Disease score was > 1600 (P = .027). Conclusions: Unexpectedly, individual surgeon experience yields bimodal effects on posttransplant outcomes, dependent on the stage of operation, operative technique, severity of recipient status, and transplant risk profile. Key words: Center volume, Donor model for end-stage liver disease score, Mortality, Risk profile IntroductionLiver transplant is one of the most complex surgical procedures, with postoperative mortality rates ranging from 3% to 12% and 5-year survival rates ranging from 70% to 75%. [1][2][3][4][5] Numerous studies available in the transplant literature have reported risk factors for poor outcomes. Those of most relevance have reported outcomes attributable to recipients, donors, and operative procedural characteristics. 1,4,6,7 In addition, the role of combined factors, such as the donor Model for End-Stage Liver Disease (D-MELD) score introduced by Halldorson and associates and derived from recipient MELD score and donor age, has been recently advocated. 8,9 However, data on the association between the individual experience of the surgeon and patient outcomes after deceased-donor liver transplant are scarce. Notably, surgeon experience has been previously reported as a factor significantly related to postoperative outcomes in other transplant procedures and in procedures in the field of general surgery. [10][11][12][13] Given the worldwide shortage of donors, the optimal utilization of the scarce resources is of basic importance. Previously, much attention has been given to the association between case volume at a particular transplant center and posttransplant outcomes. Several groups who studied related topics have found that outcomes of liver transplants performed at hig...

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Section: Discussionsupporting

confidence: 89%

Untitled

Grąt

Lewandowski²,

Patkowski³

et al. 2018

Exp Clin Transplant

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“…A cohort study found that surgeon volume was a stronger prognostic factor than hospital volume after mutual adjustment. 90 Even experienced surgeons who start to perform oesophagectomies have a learning curve before the survival outcome for their patients is stabilised. 88 Taken together, available scientific evidence supports centralisation of oesophagectomy.…”

Section: Volumementioning

confidence: 99%

Oesophageal cancer

et al. 2017

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SummaryOesophageal cancer is a clinically challenging disease requiring a multidisciplinary approach.The extensive treatment may be associated with serious limitations in health-related quality of life and yet still a poor prognosis. Recent decades have witnessed a gradual improvement in prognosis in many countries. Endoscopic procedures have increasingly been used in the treatment of premalignant and early oesophageal tumours. Neoadjuvant therapy with chemotherapy or chemoradiotherapy has supplemented surgery as standard treatment of locally advanced oesophageal cancer. Surgery has become more standardised and centralised. There are several therapeutic alternatives for palliative treatment. This review aims to provide insights into the current clinical management, on-going controversies and future needs in oesophageal cancer.3

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“…This comprehensive cohort has been presented in detail elsewhere [4]. Importantly, the study cohort included copies of the operation charts for esophageal cancer surgery from the medical records throughout Sweden during the period 1987-2010.…”

Section: Methodsmentioning

confidence: 99%

“…However, for many patients, overall survival (OS) remains limited [2,3]. Doses of at least 60 Gy in 2 Gy/fraction are frequently used [4] and clinically relevant acute radiation esophagitis (RE) is relatively common [5]. RE is found to correlate with different dose-volume parameters [6-10] and normal tissue complication probability (NTCP) models have been developed for RE [11,12].…”

Section: Letter To the Editormentioning

confidence: 99%