Short and Long-term Outcomes Among High-Volume vs Low-Volume Esophagectomy Surgeons at a High-Volume Center

• Published in: Seminars in thoracic and cardiovascular surgery Vol. 34; no. 4; pp. 1340 - 1350
• Main Authors: Dolan, Daniel, White, Abby, Lee, Daniel N., Mazzola, Emanuele, Polhemus, Emily, Kucukak, Suden, Wee, Jon O, Swanson, Scott J
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-01-2022
• Subjects: Esophageal cancer; Esophagectomy; Long-term outcomes; Peri-operative management; OS; CI; CAD; Esophagectomy; HR; Peri-operative management; DFS; LRFS; SCC; Long-term outcomes; Esophageal cancer; BMI; COPD
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2021.09.007

To determine associations between surgeon volume and esophagectomy outcomes at a high-volume institution. All esophagectomies for esophageal cancer at our institution from August 2005 to August 2019 were reviewed. Cases were divided by surgeon into low, <7 cases/year, vs high volume, ≥7 cases/year, based on Leapfrog Group recommendations. Surgeons remained ‘high-volume’ after one year of ≥7 cases. Demographics, comorbidities, course of care, and long-term outcomes were compared. In total, 1029 cases were evaluated; 120 performed by low-volume surgeons vs 909 by high-volume surgeons. Never-smokers, atrial fibrillation, and clinical Stage IVa patients were associated with high-volume surgeons. Other demographics were similar. Low-volume surgeons did more open cases, 45.8% vs 14.5%, P < 0.01. Low-volume surgeons had more complications than high-volume surgeons (71.7% vs 57.6%, P < 0.01), specifically Grade II and III (59.2% vs 46.8%, P = 0.01, and 44.2% vs 27.0%, P <0.01). No differences were seen in anastomotic leak rate, 90-day mortality, recurrences, 5-year overall survival (46.7% low-volume vs 49.3% high-volume, P = 0.64), or 5-year disease-free survival (35.7% low-volume vs 42.2% high-volume, P = 0.27). In multivariable logistic regression for Grade III or higher complications, high-volume surgeons had an odds ratio of 0.56 (95% confidence interval 0.36–0.87) for complications. Our study found higher rates of open esophagectomies and complications in low-volume esophagectomy surgeons compared to high-volume surgeons at the same, high-volume institution. However, low-volume surgeons were not associated with worse survival outcomes compared to high-volume surgeons. Low-volume esophagectomy surgeons may benefit from mentoring and support to improve perioperative outcomes; these efforts are underway at our institution.
Summary of ‘Short and Long-term Outcomes Among High-Volume vs Low-Volume Esophagectomy Surgeons at A High-Volume Center’. [Display omitted]