title: Surgeon volume is a poor proxy for skill in esophageal cancer surgery.
abstract: OBJECTIVE
  To evaluate the impact of surgeon volume on the risk of technical surgical complications after esophageal cancer resection.
  
  
  BACKGROUND
  Severe postoperative complications occur in about half of esophagectomized patients. Of these, technical complications might be particular targets for improvement. Population-based studies of the influence of surgeon volume on technical complications are sparse.
  
  
  METHODS
  A prospective, nationwide, population-based study was conducted in Sweden in 2001 through 2005. Details concerning patient and tumor characteristics, surgical procedures, and predefined complications were collected prospectively from the Swedish Esophageal and Cardia Cancer register. The surgeon volume cut-offs of <2, 2 to 6, and >6 operations per annum were predefined on the basis of previous research. Multivariable logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  Among 615 patients undergoing esophageal resection for cancer, 154 (25.0%) patients sustained at least 1 technical surgical complication. No association was found between high-volume surgery and decreased risk of such complications. Compared with high-volume surgeons, medium-volume surgeons had an adjusted OR of 0.80 (95% CI: 0.45-1.42) and low-volume surgeons had an OR of 0.99 (95% CI: 0.49-1.98) for occurrence of any technical surgical complication. Differences were found between individual HVSs regarding crude risk of anastomotic leakage (P < 0.042) and secondary surgical complications (P < 0.001).
  
  
  CONCLUSIONS
  Surgeon volume seems to be a poor proxy for skill in esophageal cancer surgery. Other factors might be of more importance, as indicated by variations in outcome between individual experienced surgeons.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. martin.rutegard@ki.se
authors.forename: Martin
authors.initials: M
authors.lastname: Rutegård
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
authors.forename: Ioannis
authors.initials: I
authors.lastname: Rouvelas
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries