Impact of Hospital Volume on Long-term Survival After Esophageal Cancer Surgery

Rouvelas, Ioannis; Lindblad, Mats; Zeng, Wei; Viklund, Pernilla; Ye, Weimin; Lagergren, Jesper

doi:10.1001/archsurg.142.2.113

Cited by 46 publications

(29 citation statements)

References 27 publications

(45 reference statements)

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“…There is considerable evidence that the transhiatal approach leads to a reduced postoperative morbidity rate [26][27][28][29] . Presumed that the transthoracic approach with an extended lymphadenectomy is technically more challenging, one could propose that the performance of transthoracic oesophagectomies in patients with a tumour located in the distal oesophagus should be regarded as a quality indicator.…”

Section: Process Measuresmentioning

confidence: 99%

Quality-of-care indicators for oesophageal cancer surgery: A review

Staal

Wouters

Boot

et al. 2010

European Journal of Surgical Oncology

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Section: Process Measuresmentioning

confidence: 99%

Quality-of-care indicators for oesophageal cancer surgery: A review

Staal

Wouters

Boot

et al. 2010

European Journal of Surgical Oncology

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“…[1][2][3] Although the underlying cause of this effect continues to be debated, the concept of a volume-outcome relationship has been shown to influence survival for elective abdominal aortic aneurysm (AAA) repair. 4 In 2007 Killeen et al 5 published an extensive review of the available literature on the volume-outcome relationship in elective AAA repair.…”

mentioning

confidence: 99%

Regionalization of abdominal aortic aneurysm repair: Evidence of a shift to high-volume centers in the endovascular era

Hill

McPhee

Messina

et al. 2008

Journal of Vascular Surgery

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Between 1998 and 2004, a trend towards the regionalization of AAA repair to high-volume centers occurred. Nearly one-third of all AAA repairs were performed at high-volume centers. There was a concurrent increase in the frequency of endovascular AAA repair, especially at high-volume centers. During this period of regionalization of AAA repair to high-volume centers, patient mortality after AAA repair decreased by 23%. Thus, the observed regionalization of AAA repair and the reduction in short-term patient mortality for this operation may be explained by increased utilization of endovascular technologies at high-volume centers.

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“…Nos centros de médio volume de esofagectomias, o case-mix do Serviço, a sua diferenciação em oncologia digestiva, resultante do aumento de referenciação e treino dos cirurgiões envolvidos, têm sido apontados como os factores que condicionam a obtenção de resultados equivalentes a outros centros com maior volume desta patologia. 3,37,38 Os nossos resultados estão a par com os encontrados por outros grupos, com sobrevida global mediana de 18 meses, sem diferenças significativas (p > 0,05) para as duas abordagens (RTM e RTT). A sobrevida de 47% aos dois anos com uma perda acentuada aos cinco anos (19%) é semelhante descrita na literatura.…”

Section: Discussionunclassified

Cancro do Esófago: Estratégia de Abordagem Cirúrgica

et al. 2014

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Acta Med Port 2014 Sep-Oct;27(5):593-600 RESUMOIntrodução: A ressecção transmediastínica e a ressecção transtorácica têm mortalidade hospitalar (1,4% -14%) e sobrevivência (± 25% aos cinco anos) semelhantes. A terapêutica neo-adjuvante é opção em estádios avançados. A intenção deste trabalho é apresentar uma série consecutiva de 52 doentes -opção operatória baseada na localização anatómica: tumores infra-carinais e cervicais submetidos a ressecção transmediastínica e restantes ressecções transtorácicas. Discussão: Não tendo sido demonstrada vantagem oncológica para a ressecção transtorácica ou a ressecção transmediastínica, basear a opção operatória na localização do tumor permitiu-nos com segurança e eficácia, planear e executar as ressecções esofági-cas desta série. Conclusão: As curvas de sobrevida foram sobreponíveis para ressecção transtorácica e ressecção transmediastínica e bastante favoráveis numa população com 52 % de estádios pIII/IV. A quimio-radioterapia contribuiu para aumentar a ressecabilidade. Palavras-chave: Esofagectomia; Laparoscopia; Neoplasias Esofágicas/cirurgia; Toracotomia. ABSTRACT Introduction:Oesophagectomy for cancer is associated to a significant morbidity and mortality. The superiority of transthoracic vs transhiatal is still a matter of controversy. The aim of this paper is to discuss the results of a series of patients submitted to either a transthoracic or a transhiatal according to the anatomic location regarding the carina. Material and Methods: Retrospective analysis of 52 consecutive patients, with oesophageal carcinoma, 7 female and 45 males, median age 64 years. Location: cervical -1; above carina -22; below or at carina level -19; cardia type I -10. 19 adenocarcinoma, 32 squamous cells, 1 lymphoma. Twenty patients (40%) -neo-adjuvant therapy. Thoracoabdominal approach -3, cervico-thoracoabdominal -20, transhiatal -27, exploratory thoracotomy -2. Gastric pull-up 49 (cervical anastomosis -46; thoracic -3); cervical oesofagocoloplasty -1. Results: Pathologic staging: complete remission -8; Ib -3; IIa -9; IIb -4; IIa -11; IIIb -2; IIIc -10; IV -1; non-stageable -3. Major complications: 37%. Resectability: 96% (50/52). Mortality: 4th week -6%; in-hospital -14%. Median survival 18 months . Survival Curves (Kaplan-Meier): 2 years -47%; 5 years -19% (transthoracic vs transhiatal p > 0.05). Discussion: Selection of surgical approach based on the anatomic location of the tumour regarding the carina was safe, the resectability was high and similar when a transthoracic or a transhiatal was planed and carry-on. Conclusions: In this series of oesophageal cancer patients, in advanced pathologic condition (52% p Stages III/IV) the overall survival was similar for transthoracic and transhiatal. Neo-adjuvant treatments definitively contributed to enhance resectability.

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Impact of Hospital Volume on Long-term Survival After Esophageal Cancer Surgery

Cited by 46 publications

References 27 publications

Quality-of-care indicators for oesophageal cancer surgery: A review

Quality-of-care indicators for oesophageal cancer surgery: A review

Regionalization of abdominal aortic aneurysm repair: Evidence of a shift to high-volume centers in the endovascular era

Cancro do Esófago: Estratégia de Abordagem Cirúrgica

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