title: Should esophagectomy be performed in a low-volume center?
abstract: A significant difference has been reported between rates of morbidity and mortality for elective esophagectomy performed at low-volume centers versus high-volume centers. Some authors have suggested that complex surgical procedures such as esophagectomy should be performed only in regional centers by surgeons with an extensive procedure-specific experience. This study was performed to review recent (5 years) experience with esophagectomy in two university-affiliated hospitals where a limited number of esophageal resections are performed annually. Esophageal resections performed between February 1995 and February 2000 at two university-affiliated tertiary-care hospitals were analyzed for operative morbidity and mortality. Variables reviewed included demographics, surgeon experience, mortality, and complications. Forty-three patients underwent elective esophagectomy during the 5-year study period. In-hospital mortality was 7.0 per cent and 30-day mortality was 4.7 per cent. The anastomotic leak rate was 11.6 per cent. No patients developed myocardial infarction or renal failure. Morbidity and mortality rates from our low-volume centers compared favorably with high-volume centers. We conclude that elective esophagectomy can be safely performed at low-volume centers with favorable morbidity and mortality rates. Recommendations urging regionalization of high-risk procedures should be guided by local outcomes and not by the total number of procedures performed at a specific center.
authors.affiliation: Department of Surgery, University of Kansas School of Medicine-Wichita, 67214, USA.
authors.forename: Rajesh S
authors.initials: RS
authors.lastname: Padmanabhan
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Byrnes
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Helmer
authors.forename: R Stephen
authors.initials: RS
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D016629:Esophagectomy / Q000009:adverse effects* / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007615:Kansas / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014600:Utilization Review