Surgery for Esophageal Cancer Should be Performed in Specialized Hospitals

Operative mortality for esophageal cancer is increased in hospitals that do to few surgeries.

Surgery for Esophageal Cancer Should be Performed in Specialized Hospitals

The number of esophagectomies performed at an institution appears to directly affect mortality (death) rates for patients undergoing this procedure, according to recent study published in the journal Cancer.

The esophagus is a muscular tube that transports food from the back of the mouth to the stomach. Cancer of the esophagus is a relatively rare, but deadly cancer. Treatment options for esophageal cancer consist of chemotherapy, radiation, endoscopic ablation techniques and/or an esophagectomy. An esophagectomy is a surgical procedure in which part of the esophagus is removed.

Since esophageal cancer is a rare cancer, typically only large-volume hospitals treat many with this disease. Moreover, the esophagus is anatomically placed such that invasive surgery, such as an esophagectomy, is associated with a high rate of complications. In response to this, researchers from the Netherlands recently analyzed data from differing facilities involving patients who had undergone an esophagectomy between 1993-1998. The aim of this study was to determine if a correlation existed between the facilities at which the patient was treated and hospital mortality rates.

Treatment facilities included hospitals that performed a low volume (1-10 procedures per year), medium volume (11-20 procedures per year) or high volume (over 50 procedures per year) of esophagectomies. Hospital mortality rates for patients were 12.1% in low-volume centers, 7.5% in medium-volume centers, and 4.9% in high-volume centers.

These results suggest that a direct correlation exists between hospital volume (specifically esophagectomies performed) and hospital mortality. Large-volume hospitals at which over 50 esophagectomies are performed a year have significantly lower hospital mortality rates than lower-volume hospitals. Patients with esophageal cancer whose treatment will include an esophagectomy should be treated at a large-volume hospital in order to receive the highest chance of an optimal outcome. (Cancer, Vol 91, No 8, pp 1574-1578, 2001)

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