title: Effect of surgical experience on results of esophagectomy for esophageal carcinoma.
abstract: BACKGROUND
  Esophagectomy for esophageal cancer is associated with substantial operative morbidity and mortality. The effect of surgical experience on results of esophagectomy has received little attention in the medical literature.
  
  
  METHODS
  A retrospective review of esophagectomies for cancer was done.
  
  
  RESULTS
  Seventy-four patients underwent esophagectomy by 20 different surgeons. Three surgeons performed 6 or more esophagectomies per year ("frequent" surgeons), whereas the other 17 surgeons performed 5 or fewer esophagectomies per year ("occasional" surgeons). Forty-two patients were operated on by frequent surgeons. There were 3 (7%) anastomotic leaks and no deaths. In 32 patients operated on by occasional surgeons, there were 7 (22%) anastomotic leaks and 7 (22%) operative deaths. The anastomotic leak rates were not significantly different (P < .07), but frequent surgeons had a significantly lower operative mortality (P < .0014).
  
  
  CONCLUSIONS
  Esophagectomy for esophageal cancer should be performed by experienced esophageal surgeons with sufficient yearly volume of procedures to maintain competence.
authors.affiliation: Division of Thoracic Surgery, Hamilton Regional Cancer Centre, Ontario, Canada.
authors.forename: J D
authors.initials: JD
authors.lastname: Miller
authors.forename: M K
authors.initials: MK
authors.lastname: Jain
authors.forename: C J
authors.initials: CJ
authors.lastname: de Gara
authors.forename: D
authors.initials: D
authors.lastname: Morgan
authors.forename: J D
authors.initials: JD
authors.lastname: Urschel
mesh_terms: D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D011361:Professional Competence; D012189:Retrospective Studies