Journal of Gastrointestinal Surgery

, Volume 12, Issue 8, pp 1346–1350 | Cite as

Mortality Rate Associated with 56 Consecutive Esophagectomies Performed at a “Low-Volume” Hospital: is Procedure Volume as Important as We are Trying to Make it?

original article



Esophagectomy procedures have been associated with high morbidity and mortality rates. Recent articles in the literature have focused on the relationship between operative volume and the rates of mortality and morbidity in association with esophagectomy. The common theme among these publications is the statistically significant correlation between high-volume centers (typically defined as at least 10 esophagectomies per year) and lower mortality rates. The authors hypothesized that an individual surgeon’s expertise with the various esophagectomy procedures would better correlate to mortality rates than the absolute number performed in an institution per year.

Study Design

The study involved a retrospective cohort of a single surgeon over a 7-year period (August 17, 1999–December 23, 2006). Selection criteria included all patients who had undergone a transhiatal esophagectomy, transabdominal with diaphragmatic split esophagectomy, or Ivor-Lewis esophagectomy procedure by a single surgeon (PP) during the specified time period. The main outcome measures were 30-day mortality and postoperative complications.


Over the 7-year study period, 56 esophagectomies were performed (average, eight per year). The 30-day morbidity and mortality rates were 48% (27/56) and 3.57% (2/56), respectively.


If low-volume esophagectomy centers are to be defined in the literature as completing <10 procedures per year, then these data represent such an institution. While several authors have demonstrated a correlation between lower mortality rates and high-volume esophagectomy hospitals, our results support surgeon experience as potentially being more significant than absolute number of procedures performed in an institution per year.


Esophagectomy Morbidity Mortality 



We acknowledge the statistical assistance of Dave McCready, MAS, and the editorial assistance of Janet L. Tremaine, ELS, Tremaine Medical Communications, Dublin, OH, USA.


  1. 1.
    Alanezi K, Urschel J. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 2004;10:71–75.PubMedGoogle Scholar
  2. 2.
    Atkins B, Shah A, Hutcheson K, Mangum J, Pappas T, Harpole D, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 2004;78:1170–1176.PubMedCrossRefGoogle Scholar
  3. 3.
    Begg C, Cramer L, Hoskins W, Brennan M. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998;280:1747–1751.PubMedCrossRefGoogle Scholar
  4. 4.
    Berger A, Scott W, Freedman G, Konski A, Weiner L, Cheng J, et al. Morbidity and mortality are not increased after induction chemoradiotherapy followed by esophagectomy in patients with esophageal cancer. Semin Oncol 2205;32:16–20.CrossRefGoogle Scholar
  5. 5.
    Cense H, Lagarde S, Jong K, Omloo J, Busch O, Henny Ch , et al. Association of no epidural analgesia with postoperative morbidity and mortality after transthoracic esophageal cancer resection. J Am Coll Surg 2006;202:395–400.PubMedCrossRefGoogle Scholar
  6. 6.
    Gockel I, Exner C, Junginger T. Morbidity and mortality after esophagectomy for esophageal carcinoma: a risk analysis. World J Surg Oncol 2005;3:37.PubMedCrossRefGoogle Scholar
  7. 7.
    Hulscher J, Tijssen J, Obertop H, van Lanschot J. Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg 2001;72:306–313.PubMedCrossRefGoogle Scholar
  8. 8.
    Law S, Wong K, Kwok K, Chu K, Wong J. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg 2004;240:791–800.PubMedCrossRefGoogle Scholar
  9. 9.
    Martin L, Swisher S, Hofstetter W, Correa A, Mehran R, Rice D, et al. Intrathoracic leaks following esophagectomy are no longer associated with increased mortality. Ann Surg 2005;242:392–402.PubMedGoogle Scholar
  10. 10.
    Marton S, Szakmany T, Papp A, Cseke L, Horvath P. Does transthoracic compared to transhiatal resection alter the early postoperative course of oesophagectomy? Dis Esophagus 2005;18:155–159.PubMedCrossRefGoogle Scholar
  11. 11.
    Michelet P, D’Journo X, Roch A, Papazian L, Ragni J, Thomas P, et al. Perioperative risk factors for anastomotic leakage after esophagectomy: influence of thoracic epidural analgesia. Chest 2005;128:3461–3466.PubMedCrossRefGoogle Scholar
  12. 12.
    Portale G, Hagen J, Peters J, Chan L, DeMeester S, Gandamihardja T, et al. Modern 5-year survival of respectable esophageal adenocarcinoma: single institution experience with 263 patients. J Am Coll Surg 2006;202:588–596.PubMedCrossRefGoogle Scholar
  13. 13.
    Rentz J, Bull D, Harpole D, Bailey S, Neumayer L, Pappas T, et al. Transthoracic versus transhiatal esophagectomy: a prospective study of 945 patients. J Thorac Cardiovasc Surg 2003;125:1114–1120.PubMedCrossRefGoogle Scholar
  14. 14.
    Junemann-Ramirez M, Awan M, Khan Z, Rahamim J. Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre. Eur J Cardiothorac Surg 2005;27:3–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Metzger R, Bollschweiler E, Vallbohmer D, Maish M, DeMeester T, Holscher A. High volume centers for esophagectomy: what is the number needed to achieve low postoperative mortality? Dis Esophagus 2004;17:310–314.PubMedCrossRefGoogle Scholar
  16. 16.
    Dimick J, Wainess R, Upchurch G, Iannettoni M, Orringer M. National trends in outcomes for esophageal resection. Ann Thorac Surg 2005;79:212–218.PubMedCrossRefGoogle Scholar
  17. 17.
    Pinotti H, Ellenbogen G, Zilberstein B. Esophagectomy by cervico abdominal approach: incision of diaphragm and transmediastinal extrapleural dissection. Chir Gastroenterol 1978;12:223–232.Google Scholar
  18. 18.
    Pinotti H, Zilberstein B, Pollara W. Esophagectomy without thoracotomy. Surg Gynecol Obstet 1981;152:345–346.Google Scholar
  19. 19.
    Peracchia A, Bardini R. Total esophagectomy without thoracotomy: results of a European questionnaire (GEEMO). Int Surg 1986;71:171–175.PubMedGoogle Scholar
  20. 20.
    Steyerberg E, Neville B, Koppert L, Lemmens V, Tilanus H, Coebergh JW, et al. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 2006;24:4277–4284.PubMedCrossRefGoogle Scholar
  21. 21.
    Birkmeyer J, Stukel T, Siewers A, Goodney P, Wennberg D, Lucas F. Surgeon volume and operative mortality in the United States. N Engl J Med 2003;349:2117–2127.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  1. 1.Department of SurgeryMount Carmel Health SystemColumbusUSA

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