Brigham and Women's Hospital, Division of Thoracic Surgery, Boston, Massachusetts.
Brigham and Women's Hospital, Division of Thoracic Surgery, Boston, Massachusetts.
Semin Thorac Cardiovasc Surg. 2022 Winter;34(4):1340-1350. doi: 10.1053/j.semtcvs.2021.09.007. Epub 2021 Sep 21.
To determine associations between surgeon volume and esophagectomy outcomes at a high-volume institution. All esophagectomies for esophageal cancer at our institution from August 2005 to August 2019 were reviewed. Cases were divided by surgeon into low, <7 cases/year, vs high volume, ≥7 cases/year, based on Leapfrog Group recommendations. Surgeons remained 'high-volume' after one year of ≥7 cases. Demographics, comorbidities, course of care, and long-term outcomes were compared. In total, 1029 cases were evaluated; 120 performed by low-volume surgeons vs 909 by high-volume surgeons. Never-smokers, atrial fibrillation, and clinical Stage IVa patients were associated with high-volume surgeons. Other demographics were similar. Low-volume surgeons did more open cases, 45.8% vs 14.5%, P < 0.01. Low-volume surgeons had more complications than high-volume surgeons (71.7% vs 57.6%, P < 0.01), specifically Grade II and III (59.2% vs 46.8%, P = 0.01, and 44.2% vs 27.0%, P <0.01). No differences were seen in anastomotic leak rate, 90-day mortality, recurrences, 5-year overall survival (46.7% low-volume vs 49.3% high-volume, P = 0.64), or 5-year disease-free survival (35.7% low-volume vs 42.2% high-volume, P = 0.27). In multivariable logistic regression for Grade III or higher complications, high-volume surgeons had an odds ratio of 0.56 (95% confidence interval 0.36-0.87) for complications. Our study found higher rates of open esophagectomies and complications in low-volume esophagectomy surgeons compared to high-volume surgeons at the same, high-volume institution. However, low-volume surgeons were not associated with worse survival outcomes compared to high-volume surgeons. Low-volume esophagectomy surgeons may benefit from mentoring and support to improve perioperative outcomes; these efforts are underway at our institution.
为了确定高容量机构中外科医生数量与食管切除术结果之间的关联。回顾了我们机构 2005 年 8 月至 2019 年 8 月期间所有食管癌的食管切除术病例。根据 Leapfrog Group 的建议，根据外科医生的手术量将病例分为低量组（<7 例/年）和高量组（≥7 例/年）。高量组的外科医生在一年中完成≥7 例手术后仍被认为是“高量”。比较了人口统计学、合并症、治疗过程和长期结果。总共评估了 1029 例；120 例由低量外科医生完成，909 例由高量外科医生完成。不吸烟者、心房颤动和临床 IVa 期患者与高量外科医生相关。其他人口统计学特征相似。低量外科医生做了更多的开放手术，45.8%比 14.5%，P<0.01。低量外科医生的并发症比高量外科医生多（71.7%比 57.6%，P<0.01），特别是 II 级和 III 级（59.2%比 46.8%，P=0.01 和 44.2%比 27.0%，P<0.01）。吻合口漏率、90 天死亡率、复发、5 年总生存率（低量组 46.7%比高量组 49.3%，P=0.64）或 5 年无病生存率（低量组 35.7%比高量组 42.2%，P=0.27）均无差异。在多变量逻辑回归分析中，高量外科医生发生 III 级或更高级别并发症的比值比为 0.56（95%置信区间为 0.36-0.87）。我们的研究发现，与高容量机构中的高容量外科医生相比，低容量外科医生的开放性食管切除术和并发症发生率更高。然而，低量外科医生的生存结果并不比高量外科医生差。低量食管切除术外科医生可能受益于指导和支持，以改善围手术期结果；我们机构正在进行这些努力。
