Volume-Outcome Relationship in Surgery for Esophageal malignancy: Systematic Review and Meta-analysis 2000-2011

Markar, Sheraz R.; Karthikesalingam, Alan; Thrumurthy, Sri G.; Low, Donald E.

doi:10.1007/s11605-011-1731-3

Cited by 251 publications

(150 citation statements)

References 27 publications

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“…Hence, our results were consistent with those of previous studies in high-volume hospitals (4,5). According to previous investigations, procedural volume is a crucial determinant of the outcome of esophagectomy (6)(7)(8).…”

Section: Discussionsupporting

confidence: 93%

Perioperative management and outcomes of minimally invasive esophagectomy: case study of a high-volume tertiary center in Taiwan

et al. 2018

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Background: Mortality and complication rates for surgical esophagectomy remain high despite progress in surgical techniques and perioperative care. Minimally invasive surgery and intraoperative goal-directed fluid management are gaining popularity in Taiwan; however, perioperative complications and shortterm outcomes have been rarely reported. In this retrospective study, we analyzed the surgical procedures performed as well as the perioperative outcomes and treatments after esophagectomy in a high-volume medical center in Taiwan Although McKeown MIE bore a significantly longer surgical time and higher intraoperatively-infused crystalloid than did Ivor Lewis MIE, there were no significant differences regarding postoperative cardiothoracic complications and patient outcomes. Conclusions: Postoperative outcomes of McKeown MIE and Ivor-Lewis MIE were comparable in our center and short term outcomes were similar to those in previous reports. However, despite neoadjuvant concurrent chemoradiation therapy (CCRT), the use of minimally invasive techniques, and well-controlled anesthesia, the incidence of perioperative complications remains high. Our results suggest that patients with preoperative comorbidity of arrhythmia, heart diseases, and CKD are associated with more common postoperative complications. Furthermore, postoperative dysrhythmias, pulmonary complications, and AKI warrant special anesthetic and surgical care to prevent prolonged ICU stay.

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Section: Discussionsupporting

confidence: 93%

Perioperative management and outcomes of minimally invasive esophagectomy: case study of a high-volume tertiary center in Taiwan

et al. 2018

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“…However it must be emphasized that salvage esophagectomy represents one of the more complex variants of esophagectomy due to the scarring effects of radiotherapy upon the operative field (24). Thus previous surgeon volume-outcome effects observed for all esophagectomy are likely to be amplified in the setting of salvage esophagectomy (25). Suggesting this procedure should only be performed in specialized high volume esophageal surgical units, with the high level of surgical and medical expertise available to manage these complex patients.…”

Section: Discussionmentioning

confidence: 99%

Salvage esophagectomy: safe therapeutic strategy?

Jamel¹,

Markar²

2017

J. Thorac. Dis.

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The objectives of this review were to assess both the short-and long-term clinical outcomes in patients managed with definitive chemoradiotherapy, and salvage esophagectomy subsequently in comparison to those neoadjuvant chemoradiotherapy followed by planned esophagectomy (NCRS) for esophageal cancer from published literature. Eleven studies comprising 1,906 patients were included, 563 in the salvage group and 1,343 in the NCRS group. Pooled analysis showed no significant difference between salvage and NCRS groups in overall survival [hazard ratio (HR) =1.17; 95% confidence interval (95% CI), CI, 1.41-2.51, P<0.001). Herein we found that salvage esophagectomy has similar short-and long-term mortality in comparison to planned esophagectomy following neoadjuvant chemoradiotherapy. However, anastomotic leak is increased following salvage esophagectomy suggesting the need for this practice to be reserved for high volume surgeons within high volume centers.

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“…[1][2][3] The overall European pooled relative 1-year and 5-year survival rates are 33.4% (95% CI, 32.9% to 33.9%) and 9.8% (95% CI, 9.4% to 10.1%), respectively. 4 Centralization of esophagectomy to high-volume centers in recent years has rendered improvements in short-term complications, postoperative mortality, [5][6][7] and long-term survival; surgeon volume is of greater importance than hospital volume. 8,9 The introduction of minimal-access surgery has highlighted the effect of surgeons gaining proficiency in new techniques.…”

Section: Introductionmentioning

confidence: 99%

Surgical Proficiency Gain and Survival After Esophagectomy for Cancer

Markar

Mackenzie

Lagergren

et al. 2016

JCO

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Purpose We aimed to identify the presence and length of esophagectomy proficiency gain curves in terms of short- and long-term mortality for esophageal cancer. Patients and Methods Patients who underwent esophagectomy for esophageal cancer between 1987 and 2010 with follow-up until 2014 were identified from a well-established, population-based, nationwide Swedish cohort study. Proficiency gain curves were created by using risk-adjusted cumulative sum analysis for 30-day, 90-day, 1-year, 3-year, and 5-year all-cause and disease-specific mortality measures. Similarly, the proficiency gain curves for lymph node harvest, resection margin status, and reoperation incidence were assessed as performance-contributing factors to the observed changes in long-term survival. Results Esophagectomies in 1,821 patients with esophageal cancer were conducted by 139 surgeons. The change-point in proficiency gain curve for all-cause 30-day mortality was early, at 15 cases, when mortality decreased from 7.9% to 3.1% (P < .001). Later change-points, which ranged from 35 to 59 cases, were observed for 1-, 3- and 5-year mortality rates, for which all-cause mortality decreased from 34.9% to 27.7% (P = .011), from 47.4% to 41.5% (P = .049), and from 31.4% to 19.1% (P = .009), respectively. Similar change-points were observed in disease-specific mortality at 1 and 3 years. There was a continuous increase in lymph node harvest, which did not plateau. Also, change-points were observed for resection margin with tumor involvement at 17 cases, with a reduction from 20.9% to 15.2% (P = .004), and for reoperation rate at 55 cases, with a reduction from 12.6% to 5.0% (P < .001). Conclusion The gain of proficiency in esophagectomy for cancer is associated with measurable changes in short- and long-term mortality results. These findings indicate a need for structured national training and mentorship programs for esophageal cancer surgery.

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Volume-Outcome Relationship in Surgery for Esophageal malignancy: Systematic Review and Meta-analysis 2000-2011

Cited by 251 publications

References 27 publications

Perioperative management and outcomes of minimally invasive esophagectomy: case study of a high-volume tertiary center in Taiwan

Perioperative management and outcomes of minimally invasive esophagectomy: case study of a high-volume tertiary center in Taiwan

Salvage esophagectomy: safe therapeutic strategy?

Surgical Proficiency Gain and Survival After Esophagectomy for Cancer

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