title: Systematic review of the impact of volume of oesophagectomy on patient outcome.
abstract: OBJECTIVE
  This systematic review aims to assess whether overall survival, mortality, morbidity, length of stay and cost of performing oesophagectomy are related to surgical volume.
  
  
  METHODS
  A systematic search strategy from 1997 until December 2006 was used to retrieve relevant studies. Inclusion of articles was established through application of a predetermined protocol, independent assessment by two reviewers and a final consensus decision.
  
  
  RESULTS
  A total of 55 studies were identified of which 27 studies, representing 68 882 patients, met the inclusion criteria. Twenty-one of these solely examined hospital volume, 5 examined both hospital and surgeon volume, and 1 examined surgeon volume in isolation. All but one of the studies were retrospective in nature, and because of the heterogeneity of the literature, no meta-analysis could be performed. Of the studies exploring the relationship between hospital volume and mortality, 20 reported a statistically significant benefit to large volume centres. Five of six included studies showed significant evidence for a reduced mortality risk with greater surgeon volume.
  
  
  CONCLUSIONS
  Based on the evidence from these retrospective studies, oesophagectomy performed in high volume centres would appear to be associated with better outcome compared with low volume centres.
authors.affiliation: University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville South, SA 5011, Australia.
authors.forename: Christopher I W
authors.initials: CI
authors.lastname: Lauder
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Marlow
authors.forename: Guy J
authors.initials: GJ
authors.lastname: Maddern
authors.forename: Bruce
authors.initials: B
authors.lastname: Barraclough
authors.forename: Neil A
authors.initials: NA
authors.lastname: Collier
authors.forename: Ian C
authors.initials: IC
authors.lastname: Dickinson
authors.forename: Jonathon
authors.initials: J
authors.lastname: Fawcett
authors.forename: John C
authors.initials: JC
authors.lastname: Graham
mesh_terms: D003362:Cost-Benefit Analysis; D016629:Esophagectomy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D006276:Health Facility Size; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016896:Treatment Outcome