title: Surgical quality of care in esophageal malignancies.
abstract: OBJECTIVE
  Esophagectomy is the primary surgical treatment for localized malignant neoplasms of the esophagus, and while outcomes have shown that substantial improvement has been made, the ceiling for improvement is still high.
  
  
  METHODS
  A total of 2506 publications published from January 2002 to March 2012 were identified from PubMed, MEDLINE and the Cochrane Library using the keywords: 'esophagectomy', 'esophagus', 'neoplasm' and 'cancer' to identify quality key surgical articles in esophagectomy that were broken down into three groups: preoperative, intraoperative and postoperative care.
  
  
  CONCLUSIONS
  There have been limited preoperative surgical trials, mostly in preoperative antibiotic use, which have led to changes in surgical management. Key and substantial changes have occurred in the intraoperative management for esophageal malignancies around surgical anastomosis technique and anesthesia. Nutritional outcomes still remain a key challenge, and currently there is no established standard of care in the postoperative management of esophagectomy patients.
  
  
  CONCLUSIONS
  We established quality parameters for leak rates, overall morbidity and mortality, and these form the foundation from which all esophageal surgeons should rank their results. We then utilized the techniques described above to maintain those rates or, better yet, to significantly improve those rates in each surgeons' practice.
authors.affiliation: Division of Surgical Oncology, University of Louisville School of Medicine, Department of Surgery, 315 East Broadway, Suite 313, Louisville, KY 40202, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Lee
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000592:standards; D011182:Postoperative Care / Q000592:standards; D011300:Preoperative Care / Q000592:standards; D011787:Quality of Health Care; D016896:Treatment Outcome