Patients who undergo surgery for esophageal cancer have a much higher chance of long-term survival if the surgeon has performed the operation many times before, according to the results of a study published in the Journal of Clinical Oncology.
The esophagus is a muscular tube that food and liquids pass through on their on their way to the stomach. Each year in the United States, more than 17,000 people are diagnosed with cancer of the esophagus and more than 15,000 die of the disease.
Treatment of esophageal cancer often involves esophagectomy, which is surgical removal of the entire esophagus. Although surgery is regarded as the only curative option for resectable esophageal cancer, the procedure carries substantial risks and only one-third of patients survive for five or more years afterward. Some research has indicated that hospital and surgeon volume may impact short-term survival, but few studies have examined the relationship between surgeon volume and long-term survival.
In the most comprehensive study to date on the topic, researchers conducted a nationwide Swedish population-based cohort study of 1,335 patients with esophageal cancer who underwent esophageal resection between 1987 and 2005—and included follow-up until February 2011. Researchers analyzed the relationship between annual hospital volume, annual surgeon volume, cumulative surgeon volume, and risk of mortality.
While there appeared to be no relationship between hospital volume and long-term survival, there was an association with surgeon volume and long-term survival. In fact, patients who underwent surgery with surgeons who performed a high volume of the surgery (both annually and in total) had better outcomes—a 22 percent lower long-term mortality compared with patients who were operated on by surgeons with a low annual and total operation volume.
The researchers concluded that surgeon volume can influence the long-term survival of patients and they recommend that this surgical procedure should be concentrated among fewer surgeons.
Derogar M, Sadr-Azodi O, Johar A, et al. Hospital and surgeon bolume in relation to survival after esophageal cancer surgery in a population-based study. Journal of Clinical Oncology. Published early online: January 7, 2013. doi: 10.1200/JCO.2012.46.1517