Parise Paolo, Elmore Ugo, Fumagalli Uberto, De Manzoni Giovanni, Giacopuzzi Simone, Rosati Riccardo
Division of Gastrointestinal Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy.
Unit of Upper GI Surgery, Humanitas Research Institute, Rozzano, Italy.
Updates Surg. 2016 Jun;68(2):129-33. doi: 10.1007/s13304-016-0374-z. Epub 2016 May 30.
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.
西方国家食管癌的发病率正在迅速上升。由于生活方式的改变，腺癌最近已成为最常见的亚型。正如在其他类型的手术中所观察到的那样，即使是食管手术，在手术量大的中心也能观察到更好的效果。像英国和荷兰这样有正式集中化政策的国家，其死亡率低于集中化项目实施前以及没有集中化项目的国家，且患者生存期更长。然而，不同国家都出现了对社会经济地位较低阶层前往手术量大的医院就医便利性的担忧。在意大利，大多数癌症食管切除术是在经验有限、手术量极低的中心进行的。每年手术量超过20例的高手术量中心很少，但即使是治疗合并症更严重的患者，这些中心的死亡率也更低，住院时间也更短。本文的目的是确定将一个中心认证为食管外科中心所需的组织、结构和手术量要求。必须特别关注多学科方法，即组建一个由不同高技能专家组成的多学科团队，并制定个性化的诊断和治疗路径。
