title: Esophagectomy outcomes at a mid-volume cancer center utilizing prospective multidisciplinary care and a 2-surgeon team approach.
abstract: BACKGROUND
  Esophagectomy is associated with high morbidity and mortality, leading to calls for restricted performance at high-volume centers.
  
  
  METHODS
  Patients with esophageal cancer were evaluated prospectively in a multidisciplinary tumor board from January 2012 - December 2012. A 2-surgeon team was utilized and detailed outcomes were assessed prospectively.
  
  
  RESULTS
  Thirty-one patients underwent esophagectomy, 20 patients underwent laparoscopic transhiatal (65%) approach, and 11 patients underwent laparoscopically assisted Ivor-Lewis (35%) approach. Eighty-one percent of the patients were male, with a median age of 64 years (range: 35 to 83 years) and 73% of the patients had adenocarcinoma. Neoadjuvant chemoradiation was performed in 79% of the patients. R0 resection was achieved in 29 (94%) patients, median nodes identified were 15. Major complications (grade III to V) occurred in 13 (42%) patients and did not correlate with surgical techniques, anastomotic leak occurred in 5 (16%) patients, and significant pulmonary complications occurred in 11 (35%) patients. The length of stay at the hospital was 10 days, readmission rate 23%, and 30-day mortality rate 6%.
  
  
  CONCLUSIONS
  High-quality esophagectomy can be performed safely at a mid-volume cancer center. Our outcomes question the reliance on volume alone as an indicator of cancer surgical quality.
authors.affiliation: Metro Cancer Center, Metro Health Hospital, 5950 Metro Way, Wyoming, MI 49519, USA; College of Human Medicine, Michigan State University, Grand Rapids, MI, USA. Electronic address: Laurence.mccahill@metrogr.org.
authors.forename: Laurence E
authors.initials: LE
authors.lastname: McCahill
authors.affiliation: Lacks Cancer Center at Mercy Health-Saint Mary's, Grand Rapids, MI, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: May
authors.affiliation: Grand River Gastroenterology, MI, USA.
authors.forename: Jay Bradley
authors.initials: JB
authors.lastname: Morrow
authors.affiliation: Metro Cancer Center, Metro Health Hospital, 5950 Metro Way, Wyoming, MI 49519, USA; Lacks Cancer Center at Mercy Health-Saint Mary's, Grand Rapids, MI, USA.
authors.forename: Sharif
authors.initials: S
authors.lastname: Khandavalli
authors.affiliation: Lacks Cancer Center at Mercy Health-Saint Mary's, Grand Rapids, MI, USA.
authors.forename: Behooz
authors.initials: B
authors.lastname: Shabahang
authors.affiliation: Grand Health Partners, Grand Rapids, MI, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Kemmeter
authors.affiliation: College of Human Medicine, Michigan State University, Grand Rapids, MI, USA; Lacks Cancer Center at Mercy Health-Saint Mary's, Grand Rapids, MI, USA.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Pimiento
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D010348:Patient Care Team; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Quality assurance; Surgical outcomes; Surgical team