Metzger R, Bollschweiler E, Vallböhmer D, Maish M, DeMeester T R, Hölscher A H
Department of Visceral and Vascular Surgery, University of Cologne, Germany.
Dis Esophagus. 2004;17(4):310-4. doi: 10.1111/j.1442-2050.2004.00431.x.
Aimed at reducing surgical deaths, several initiatives have attempted to establish volume-based referral strategies in high risk surgery. The detailed analysis of the literature of the last 10 years, comprising 13 papers on esophageal cancer, shows a clear reduction in postoperative mortality with increasing case volumes per year. Single papers have analyzed the main reasons for this phenomenon and showed that postoperative complication rates are lower in high-volume hospitals and management of complications is more successful. Further, long-term prognosis is also correlated to case-volume. In conclusion, the analysis shows that only with the experience of more than 20 esophagectomies per year can a significant reduction of the mortality, down to 4.9%, be achieved. Based on this survey, surgery of esophageal cancer is a task for high-volume hospitals because of decreased postoperative mortality and improved long-term prognosis compared with low volume hospitals.
为了降低手术死亡率，多项举措试图在高风险手术中建立基于手术量的转诊策略。对过去10年文献的详细分析，包括13篇关于食管癌的论文，显示随着每年病例数的增加，术后死亡率明显降低。个别论文分析了这一现象的主要原因，表明高手术量医院的术后并发症发生率较低，并发症的处理也更成功。此外，长期预后也与手术量相关。总之，分析表明，只有每年进行超过20例食管癌切除术，才能显著降低死亡率，降至4.9%。基于这项调查，与低手术量医院相比，由于术后死亡率降低和长期预后改善，食管癌手术是高手术量医院的任务。
