title: Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer.
abstract: We aim to compare the outcomes of patients undergoing R0 esophagectomy by a multidisciplinary team (MDT) with outcomes after surgery alone performed by surgeons working independently in a UK cancer unit. An historical control group of 77 consecutive patients diagnosed with esophageal cancer and undergoing surgery with curative intent by six general surgeons between 1991 and 1997 (54 R0 esophagectomies) were compared with a group of 67 consecutive patients managed by the MDT between 1998 and 2003 (53 R0 esophagectomies, 26 patients received multimodal therapy). The proportion of patients undergoing open and closed laparotomy and thoracotomy decreased from 21% and 5%, respectively, in control patients, to 13% and 0% in MDT patients (chi2 = 11.90, DF = 1, P = 0.001; chi2 = 5.45, DF = 1, P = 0.02 respectively). MDT patients had lower operative mortality (5.7%vs. 26%; chi2 = 8.22, DF = 1, P = 0.004) than control patients, and were more likely to survive 5 years (52%vs. 10%, chi2 = 15.05, P = 0.0001). In a multivariate analysis, MDT management (HR = 0.337, 95% CI = 0.201-0.564, P < 0.001), lymph node metastases (HR = 1.728, 95% CI = 1.070-2.792, P = 0.025), and American Society of Anesthesiologists grade (HR = 2.207, 95% CI = 1.412-3.450, P = 0.001) were independently associated with duration of survival. Multidisciplinary team management and surgical subspecialization improved outcomes after surgery significantly for patients diagnosed with esophageal cancer.
authors.affiliation: Gwent Healthcare NHS Trust, Royal Gwent Hospital, Newport, UK.
authors.forename: M R
authors.initials: MR
authors.lastname: Stephens
authors.forename: W G
authors.initials: WG
authors.lastname: Lewis
authors.forename: A E
authors.initials: AE
authors.lastname: Brewster
authors.forename: I
authors.initials: I
authors.lastname: Lord
authors.forename: G R J C
authors.initials: GR
authors.lastname: Blackshaw
authors.forename: I
authors.initials: I
authors.lastname: Hodzovic
authors.forename: G V
authors.initials: GV
authors.lastname: Thomas
authors.forename: S A
authors.initials: SA
authors.lastname: Roberts
authors.forename: T D L
authors.initials: TD
authors.lastname: Crosby
authors.forename: C
authors.initials: C
authors.lastname: Gent
authors.forename: M C
authors.initials: MC
authors.lastname: Allison
authors.forename: K
authors.initials: K
authors.lastname: Shute
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000465:Algorithms; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010348:Patient Care Team; D016016:Proportional Hazards Models; D016896:Treatment Outcome