title: Esophageal surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it.
abstract: Esophageal cancer incidence is rapidly increasing in the western countries. Adenocarcinoma has recently become the most frequent subtype because of the changes in lifestyle. As observed for other types of surgery, even for esophageal surgery better results have been observed in centers with high volume of activity. Countries with formal policies of centralization, as Great Britain and The Netherlands, have got lower mortality and longer survival than those obtained before the centralization program introduction and of those countries without centralization programs. However, concerns about accessibility to high volume hospitals for lower level social strata have emerged in different countries. In Italy most of the esophagectomies for cancer are performed in very low volume centers with limited experience. High volume centers with >20 cases/year are few but, even if managing patients with more severe comorbidities have got a lower mortality and a shorter length of stay. The Aim of this paper is to identify the organizational, structural and volume requirements for accreditation of a center as an esophageal surgery center. Special attention must be given to a multidisciplinary approach involving different highly skilled specialists with the creation of a multidisciplinary team and individualized diagnostic and therapeutic pathways.
authors.affiliation: Division of Gastrointestinal Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy. parise.paolo@hsr.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Parise
authors.affiliation: Division of Gastrointestinal Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Elmore
authors.affiliation: Unit of Upper GI Surgery, Humanitas Research Institute, Rozzano, Italy.
authors.forename: Uberto
authors.initials: U
authors.lastname: Fumagalli
authors.affiliation: Division of General and GI Surgery, University of Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Manzoni
authors.affiliation: Division of General and GI Surgery, University of Verona, Verona, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Giacopuzzi
authors.affiliation: Division of Gastrointestinal Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rosati
mesh_terms: D000068:Accreditation; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D006757:Hospital Units; D006801:Humans; D007558:Italy; D062606:Tertiary Care Centers
keywords: Centralization; Esophageal cancer; Esophagectomy; High volume hospitals; Volume outcome