title: Surgeon Age in Relation to Prognosis After Esophageal Cancer Resection.
abstract: It was hypothesized that patient survival improves with increasing surgeon age up to an age where it then decreases.
  
  
  
  Experience, physical and psychological abilities required for esophagectomy may change with increasing surgeon age.
  
  
  
  This population-based cohort study included all patients having undergone esophagectomy for esophageal cancer in Sweden in 1987 to 2010, with follow-up until 2016. Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed to estimate the relation between surgeon age and 90-day mortality, all-cause, and disease-specific 5-year mortality. Change-points in surgeon age identified by the RA-CUSUM were then analyzed in relation to mortality using multivariable Cox regression, providing hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, tumor stage, tumor histology, neoadjuvant therapy, surgeon volume, and calendar year.
  
  
  
  Among 139 surgeons performing 1761 esophagectomies, RA-CUSUM analysis of 90-day mortality showed change-points at 43 years (downward deflection) and at 56 years (upward deflection). Both all-cause and disease-specific 5-year mortality had corresponding change-points at 52 years and 56 years. Compared with surgeon age 52 to 55 years, surgeon age ≤51 years was associated with increased 90-day mortality (HR = 1.71, 95% CI 1.01-2.90) and 5-year all-cause mortality (HR = 1.21, 95% CI 1.02-1.43), and surgeon age ≥56 years showed increased 90-day mortality (HR = 2.38, 95% CI 1.38-4.13), 5-year all-cause mortality (HR = 1.29, 95% CI 1.08-1.55), and disease-specific 5-year mortality (HR = 1.18, 95% CI 1.01-1.42).
  
  
  
  Surgeon age ≤51 and ≥56 years may increase short- and long-term mortality after esophagectomy for cancer.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.|Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
authors.forename: Hugh
authors.initials: H
authors.lastname: Mackenzie
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.|Division of Cancer Studies, King's College London, and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D020379:Risk Adjustment; D066231:Surgeons / Q000523:psychology* / Q000592:standards; D013548:Sweden; D016896:Treatment Outcome; D055815:Young Adult