title: Early outcomes of surgery for oesophageal cancer in a thoracic regional unit. Can we maintain training without compromising results?
abstract: OBJECTIVE
  Meaningful exposure to oesophageal cancer surgery during general thoracic surgical training is restricted to few centres in the United Kingdom. Our Regional Tertiary Unit remains a rare 'large-volume' oesophagectomy centre. We aimed to determine the proportion of patients operated by trainees and their perioperative outcomes.
  
  
  METHODS
  From January 2004 to September 2009, 323 patients (229 male and 94 female, median age of 69 (range 40-92) years) underwent oesophagectomy for carcinoma in our Thoracic Surgical Unit. Data were complete and obtained from a prospective departmental database. The preoperative characteristics, operative data and postoperative results were compared between the 120 patients (37%) operated by a trainee (group T) and the remainder 203 patients operated by a consultant (group C).
  
  
  RESULTS
  The overall incidence of mortality, anastomotic leak and chylothorax were 6.5%, 5.3% and 2.2%, respectively. There were no differences in terms of age, gender, tumour location, tumour staging, preoperative spirometry or use of neoadjuvant chemotherapy between the two groups. There was no significant difference between the consultant group and the trainee group in the following key outcome measures: postoperative mortality (8% vs 4%), incidence of respiratory complications (30% vs 25%), hospital stay (14 days vs 13 days) and number of lymph nodes excised (median of 16 vs 14).
  
  
  CONCLUSIONS
  Training in oesophageal cancer surgery can be provided in a large-volume thoracic surgical unit. It does not seem to compromise outcomes or use of resources.
authors.affiliation: Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Sumana D M
authors.initials: SD
authors.lastname: Handagala
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Addae-Boateng
authors.forename: David
authors.initials: D
authors.lastname: Beggs
authors.forename: John P
authors.initials: JP
authors.lastname: Duffy
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Martin-Ucar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003253:Consultants; D004503:Education, Medical, Graduate / Q000379:methods / Q000592:standards*; D004739:England; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000193:education* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012041:Regional Medical Programs / Q000592:standards; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D013903:Thoracic Surgery / Q000193:education*; D016896:Treatment Outcome