No influence of surgical volume on patients' health-related quality of life after esophageal cancer resection.
BACKGROUND
Studies on factors that can counteract the negative impact of esophagectomy on patients' health-related quality of life (HRQL) have been sparse. This study was undertaken to examine the question whether hospital or surgeon volume influences HRQL as evaluated 6 months after such surgery.


METHODS
A Swedish prospective, population-based cohort study of esophageal cancer patients treated surgically in 2001-2005 was conducted. All patients completed validated HRQL questionnaires, developed by EORTC, addressing general HRQL (QLQ-C30) and esophageal-specific symptoms (QLQ-OES18), 6 months postoperatively. Mean scores with 95% confidence intervals were calculated. Clinically relevant mean score differences (>/=10) between groups were further analyzed in a linear regression model, adjusted for several potential confounders.


RESULTS
Some 355 patients were included (80% of eligible). No clinically relevant differences were found between low-volume (0-9 operations/year) and high-volume hospitals (>9 operations/year) or between low-volume (0-6 operations/year) and high-volume surgeons (>6 operations/year). Stratified analyses for tumor location did not reveal any differences between hospital or surgeon volume groups. Moreover, no material differences were found between the four individual high-volume hospitals.


CONCLUSIONS
This study revealed no HRQL advantages of being treated at high-volume hospitals or by high-volume surgeons, as measured 6 months after esophageal cancer resection.
Department of Molecular Medicine and Surgery, Unit of Esophageal and Gastric Research (ESOGAR), Karolinska Institutet, Stockholm, Sweden. martin.rutegard@ki.se
Martin
M
Rutegård
Pernilla
P
Lagergren
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D016526:Workload