Abstract
Introduction
Esophagectomy is performed by general and thoracic surgeons with the type of operation often dictated by the surgeons’ training. The objective was to investigate outcomes of esophagectomy to determine if they varied according to surgeon’s training.
Methods
Clinical data of patients who underwent partial or total esophagectomy for esophageal cancer from 2003 through 2007 were obtained from the University HealthSystem Consortium database. Data were examined between general versus thoracic surgeon and were reviewed for number and type of operations performed, demographics, length of stay, and postoperative morbidity and mortality.
Results
During the 54-month period, 2,657 esophagectomies were performed; 1,079 (41%) by general surgeons and 1,578 (59%) by thoracic surgeons. More blunt transhiatal esophagectomies were performed by general surgeons compared to thoracic surgeons (56% vs. 37%, p < 0.01) while more Ivor Lewis resections were performed by thoracic surgeons (63% vs. 44%, p < 0.01). Thoracic surgery certification did not significantly affected outcomes with regards to mean hospital and ICU stay, complications, observed mortality, and mortality index.
Conclusions
In academic centers, the majority of esophagectomies for carcinoma are performed by thoracic surgeons who favor the Ivor Lewis approach, while general surgeons favor the blunt transhiatal approach. Despite these differences, specialty training does not appear an important factor affecting outcome.
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References
Goodney PP, Lucas FL, Stukel TA, Birkmeyer JD. Surgeon specialty and operative mortality with lung resection. Ann Surg 2005;241:179–184.
Callahan MA, Christos PJ, Gold HT, Mushlin AI, Daly JM. Influence of surgical subspecialty training on in-hospital mortality for gastrectomy and colectomy patients. Ann Surg 2003;238:629–636.
Cowan JA Jr, Dimick JB, Thompson BG, Stanley JC, Upchurch GR Jr. Surgeon volume as an indicator of outcomes after carotid endarterectomy: an effect independent of specialty practice and hospital volume. J Am Coll Surg 2002;195:814–821. doi:10.1016/S1072-7515(02)01345-5.
Hannan EL, Popp AJ, Feustel P, Halm E, Bernardini G, Waldman J et al. Association of surgical specialty and processes of care with patient outcomes for carotid endarterectomy. Stroke 2001;32:2890–2897. doi:10.1161/hs1201.099637.
Dimick JB, Goodney PP, Orringer MB, Birkmeyer JD. Specialty training and mortality after esophageal cancer resection. Ann Thorac Surg 2005;80:282–286. doi:10.1016/j.athoracsur.2005.01.044.
Rouvelas I, Jia C, Viklund P, Lindblad M, Lagergren J. Surgeon volume and postoperative mortality after oesophagectomy for cancer. Eur J Surg Oncol 2006;33:162–168. doi:10.1016/j.ejso.2006.10.029.
Migliore M, Choong CK, Lim E, Goldsmith KA, Ritchie A, Wells FC. A surgeon’s case volume of oesophagectomy for cancer strongly influences the operative mortality rate. Eur J Cardiothorac Surg 2007;32:375–380. doi:10.1016/j.ejcts.2007.04.014.
Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med 2003;349:2117–2127. doi:10.1056/NEJMsa035205.
Migliore M, Choong CK, Lim E, Goldsmith KA, Ritchie A, Wells FC. A surgeon's case volume of oesophagectomy for cancer strongly influences the operative mortality rate. Eur J Cardiothorac Surg 2007;32:375–380. doi:10.1016/j.ejcts.2007.04.014.
Lin HC, Xirasagar S, Lee HC, Chai CY. Hospital volume and inpatient mortality after cancer-related gastrointestinal resections: the experience of an Asian country. Ann Surg Oncol 2006;13:1182–1188. doi:10.1245/s10434-006-9005-0.
Metzger R, Bollschweiler E, Vallböhmer D, Maish M, DeMeester TR, Hölscher AH. High volume centers for esophagectomy: what is the number needed to achieve low postoperative mortality? Dis Esophagus 2004;17:310–314. doi:10.1111/j.1442-2050.2004.00431.x.
Finlayson EV, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery: a national study. Arch Surg. 2003;138:721–725. doi:10.1001/archsurg.138.7.721.
Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg 2007;245:777–783. doi:10.1097/01.sla.0000252402.33814.dd.
Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE. The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg 2004;240:586–593.
Callcut RA, Breslin TM. Shaping the future of surgery: the role of private regulation in determining quality standards. Ann Surg 2006;243:304–312. doi:10.1097/01.sla.0000200854.34298.e3.
Chang AD, Ji H, Birkmeyer NJ, Orringer MB, Birkmeyer JD. Outcomes after transhiatal and transthoracic esophagectomy for cancer. Ann Thorac Surg 2008;85:424–429. doi:10.1016/j.athoracsur.2007.10.007.
Hulscher JBF, van Sandick JW, de Boer AGEM, Wijnhoven BPL, Tijssen JGP, Fockens P et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2005;347:1662–1669. doi:10.1056/NEJMoa022343.
Omloo JMT, Lagarde SM, Hulsher JBF, Reitsma JB, Fockens P, van Dekken H et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus. Five-year survival of a randomized clinical trial. Ann Surg 2007;246(6):992–1001.
Bogoevski D, Onken F, Koenig A, Kaifi JT, Schurr P, Sauter G et al. Is it time for a new TNM classification in esophageal carcinoma? Ann Surg 2008;247:633–641.
Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL. Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg 2007;246:363–374. doi:10.1097/SLA.0b013e31814697f2.
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Smith, B.R., Hinojosa, M.W., Reavis, K.M. et al. Outcomes of Esophagectomy According to Surgeon’s Training: General vs. Thoracic. J Gastrointest Surg 12, 1907–1911 (2008). https://doi.org/10.1007/s11605-008-0664-y
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DOI: https://doi.org/10.1007/s11605-008-0664-y