Impact of a Hospital’s Workload on Clinical Outcome after Resection for Carcinoma of the Esophagus

Abstract

Surgery for esophageal cancer is a demanding procedure associated with a high rate (30%-40%) of post-operative complications. Therefore, for esophageal cancer surgery, not only must the surgeon be trained for preoperative preparation, operative therapy, and post-operative management, but also the entire hospital setting including physicians of different specialties and intensive care units. In the past few years publications have been particularly concerned with comparing the outcomes of high-volume centers and other hospitals in cases of various tumor operations. Due to more experience, increased frequency of cases and better training conditions in high-volume centers, esophagectomies have been shown to have better outcomes, especially hospital mortality, when performed there than in centers performing them with less frequency. This review of the current literature for esophageal cancer surgery shows a clear reduction of postoperative mortality with increasing case volume per year. Single papers have analysed the main reasons for this phenomenon and showed that postoperative complication rates are lower in high-volume-hospitals and their management of complications is more succesful. In conclusion, the analysis shows that only with the experience of more than 20 esophagectomies per year a significant reduction of the mortality down to <5% can be achieved.