Glatz Torben, Höppner Jens
Department of General and Visceral Surgery, University of Freiburg, Freiburg i. Br., Germany.
Visc Med. 2017 May;33(2):135-139. doi: 10.1159/000458454. Epub 2017 Mar 24.
Advances regarding perioperative mortality rates and oncological outcomes after esophagectomy have been reported extensively by specialized high-volume centers in Europe and the USA over the last decade. However, recent database analyses reveal that the perioperative mortality of esophagectomy remains high in these countries, indicating a discrepancy between surgical quality in baseline hospitals and specialized centers.
This article provides an overview over the existing literature on the correlation between structural quality, procedural volume, and surgical outcome in e- sophageal surgery.
Structural, procedural and outcome measures can be used to assess the quality of surgical treatment and perioperative management. Surgical procedures on the esophagus for both benign and malignant diseases are rare and typically associated with high perioperative morbidity and mortality. Usually, direct outcome measures do not provide enough statistical power to actually identify differences in surgical quality between hospitals, making structural quality measures the only feasible parameter to compare the quality of e- sophageal surgery among different centers. Several analyses from different countries have shown a strong correlation between hospital volume and postoperative mortality. Data from countries in which esophageal surgery has been centralized indicate beneficial effects of a centralized health care system on postoperative mortality after esophagectomy. Additionally, only high-volume centers generally provide optimal preoperative and postoperative management and comprehensive access to modern multimodal treatment. In Germany, esophageal surgery is still decentralized, but hospitals performing complex esophageal procedures have to fulfill minimum caseload requirements of 10 cases per year. In practice, these requirements are not met by the majority of hospitals and a detrimental effect on the achieved surgical outcomes can be noted.
Therefore, we conclude that structural quality assurance is crucial to further reduce postoperative morbidity after esophageal surgery and to improve long-term results.
在过去十年中，欧洲和美国的专业高容量中心广泛报道了食管癌切除术后围手术期死亡率和肿瘤学结局方面的进展。然而，最近的数据库分析显示，这些国家食管癌切除术的围手术期死亡率仍然很高，这表明基层医院和专业中心的手术质量存在差异。
本文概述了关于食管癌手术中结构质量、手术量与手术结局之间相关性的现有文献。
结构、手术和结局指标可用于评估手术治疗质量和围手术期管理。食管的良性和恶性疾病手术均较为罕见，通常伴有较高的围手术期发病率和死亡率。通常，直接的结局指标没有足够的统计效力来实际识别不同医院之间手术质量的差异，这使得结构质量指标成为比较不同中心食管癌手术质量的唯一可行参数。来自不同国家的多项分析表明，医院手术量与术后死亡率之间存在密切相关性。食管手术已实现集中化的国家的数据表明，集中化医疗系统对食管癌切除术后的死亡率有有益影响。此外，只有高容量中心通常能提供最佳的术前和术后管理，并全面提供现代多模式治疗。在德国，食管癌手术仍呈分散状态，但进行复杂食管手术的医院必须满足每年至少10例的病例数要求。实际上，大多数医院并未达到这些要求，并且可以注意到这对手术结局产生了不利影响。
因此，我们得出结论，结构质量保证对于进一步降低食管癌手术后的发病率和改善长期结果至关重要。
