Thoracic Surgeons & High-Volume Hospitals Improve Survival for Esophageal Cancer

Choosing where to have surgery for esophageal cancer may be the most important decision you make.

Thoracic Surgeons & High-Volume Hospitals Improve Survival for Esophageal Cancer

by CD Buckner Medical Editor

According to research published in the Annals of Thoracic Surgery, patients with esophageal cancer who are to undergo surgery have improved survival if they are treated by thoracic surgeons or at hospitals that perform larger volumes of surgery for esophageal cancer.

Several prior publications have indicated that outcomes of patients undergoing surgery may be significantly improved if they are treated in hospitals that have performed large volumes of such procedures. These results are credited to such hospitals’ more skilled and dedicated healthcare teams (including surgeons) who are experienced in high-risk situations.

This issue continues to be evaluated as physicians and patients determine the optimal therapeutic choices for their situations. Many patients live far from large facilities that perform large volumes of specific procedures; travel and housing during the procedure and follow-up can be a large burden for patients and their caregivers.

Researchers from the several institutions in the U.S. recently conducted a study to evaluate possible associations between survival, surgeon training, and hospital volume in patients undergoing surgery for esophageal cancer. This study included over 1,900 patients in the national Medicare population who underwent surgery between 1998 and 1999. Patients who had surgery performed by thoracic surgeons (those with specialty training and certified by the American Board of Thoracic Surgery) and those treated in hospitals that performed a large annual volume of these procedures had significantly improved survival compared with their counterparts.

  • Mortality rates were reduced by 37% among patients who were treated by a thoracic surgeon compared to those treated by a surgeon without specialty training.
  • Patients who were treated by surgeons without special training, but who had performed a high volume of procedures, had mortality rates similar to those treated by thoracic surgeons.
  • Mortality rates were 24.3% for patients treated at hospitals in which a low volume of procedures have been performed.
  • Mortality rates were 11.4% for patients treated at hospitals in which a high volume of procedures have been performed.

The researchers concluded that specialty training in thoracic surgery and hospital and surgeon volume all influence the outcome of surgery for esophageal cancer. Patients diagnosed with esophageal cancer who are to undergo surgery may wish to speak with their surgeons regarding volumes of this procedure performed by specific hospitals. They may also wish to inquire about surgeons’ credentials or the volume of these procedures they have performed.

Reference: Dimick J, Goodney P, Orringer M, Birkmeyer J, et al. Specialty Training and Mortality After Esophageal Cancer Resection. Annals of Thoracic Surgery. 2005;80:282-286.

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