Guadagni Simone, Comandatore Annalisa, Furbetta Niccolò, Di Franco Gregorio, Bechini Bianca, Vagelli Filippo, Ramacciotti Niccolò, Gaeta Raffaele, Pollina Luca Emanuele, Palmeri Matteo, Di Candio Giulio, Morelli Luca
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy.
Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, University of Pisa, Pisa, Italy.
Langenbecks Arch Surg. 2025 Apr 2;410(1):115. doi: 10.1007/s00423-025-03684-x.
High case volumes for specific surgeries including the treatment of esophagogastric junction and distal esophageal cancer are frequently emphasized in literature to achieve better outcomes. However, recent studies have suggested that a cumulative volume of major oncologic surgeries (MOSs) can positively impact outcomes for single procedures even if below their specific thresholds. This study aimed to report outcomes from esophagogastrectomies with intrathoracic anastomosis (EGs-ITA) from a surgical unit that handles a high volume of other MOSs despite lower volumes for EGs-ITA.
Data from all patients undergoing EGs-ITA from January 2013 to June 2023 were collected from an institutional database and retrospectively analyzed. Additionally, data on the volume of all MOSs performed in the same 10-year period were retrieved.
This study included 32 patients, averaging three EGs-ITA performed annually. The anastomotic leak rate was 6.2%. The median hospital stay was 12 days, and 30- and 90-day mortality rates were 3.1% and 6.2%, respectively. The mean harvested lymph nodes were 26.3 ± 10.2. Re-admission and locoregional recurrence occurred in 6.2% and 9.3% of patients, respectively. During the study period, the surgical team managed over 400 MOSs annually.
Exposure to high volume and broad range of MOSs appears beneficial for achieving favorable outcomes in esophagogastric junction and distal esophageal cancer surgeries, even in centers with lower volumes of these specific procedures. This finding underscores the potential for excellent surgical results in settings with substantial overall volumes in major oncologic procedures, as an alternative to high-volume specialization in a single surgery type.
文献中经常强调特定手术的高病例量，包括食管胃交界部和远端食管癌的治疗，以取得更好的治疗效果。然而，最近的研究表明，即使低于特定阈值，主要肿瘤手术（MOS）的累积量也可以对单个手术的结果产生积极影响。本研究旨在报告来自一个手术单元的胸内吻合食管胃切除术（EGs-ITA）的结果，该手术单元处理大量其他MOS，尽管EGs-ITA的量较低。
从机构数据库中收集2013年1月至2023年6月所有接受EGs-ITA的患者的数据，并进行回顾性分析。此外，还检索了同一10年期间进行的所有MOS的量的数据。
本研究包括32例患者，平均每年进行3例EGs-ITA。吻合口漏率为6.2%。中位住院时间为12天，30天和90天死亡率分别为3.1%和6.2%。平均收获淋巴结数为26.3±10.2。再入院率和局部区域复发率分别为6.2%和9.3%。在研究期间，手术团队每年管理超过400例MOS。
接触大量和广泛的MOS似乎有利于在食管胃交界部和远端食管癌手术中取得良好的治疗效果，即使在这些特定手术量较低的中心也是如此。这一发现强调了在主要肿瘤手术总量较大的情况下取得优异手术效果的潜力，作为单一手术类型高手术量专业化的替代方案。
