TITLE

Should Esophagectomy Be Performed in a Low-Volume Center?

AUTHOR(S)
Padmanabhan, Rajesh S.; Byrnes, Matthew C.; Helmer, Stephen D.; Smith, R. Stephen
PUB. DATE
April 2002
SOURCE
American Surgeon;Apr2002, Vol. 68 Issue 4, p348
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
A significant difference has been reported between rates of morbidity and mortality for elective esophagectomy performed at low-volume centers versus high-volume centers. Some authors have suggested that complex surgical procedures such as esophagectomy should be performed only in regional centers by surgeons with an extensive procedure-specific experience. This study was performed to review recent (5 years) experience with esophagectomy in two university-affiliated hospitals where a limited number of esophageal resections are performed annually. Esophageal resections performed between February 1995 and February 2000 at two university-affiliated tertiary-care hospitals were analyzed for operative morbidity and mortality. Variables reviewed included demographics, surgeon experience, mortality, and complications. Forty-three patients underwent elective esophagectomy during the 5-year study period. In-hospital mortality was 7.0 per cent and 30-day mortality was 4.7 per cent. The anastomotic leak rate was 11.6 per cent. No patients developed myocardial infarction or renal failure. Morbidity and mortality rates from our low-volume centers compared favorably with high-volume centers. We conclude that elective esophagectomy can be safely performed at low-volume centers with favorable morbidity and mortality rates. Recommendations urging regionalization of high-risk procedures should be guided by local outcomes and not by the total number of procedures performed at a specific center.
ACCESSION #
6596558

 

Related Articles

  • Colon interposition in the treatment of esophageal caustic strictures: 40 years of experience. Knežević, J. Ð.; Radovanović, N. S.; Simić, A. P.; Kotarac, M. M.; Skrobić, O. M.; Konstantinović, V. D.; Peško, P. M. // Diseases of the Esophagus;Dec2007, Vol. 20 Issue 6, p530 

    The objective of this article was to analyze 40 years of experience of colon interposition in the surgical treatment of caustic esophageal strictures from the standpoints of our long-term personal experience. Colon interposition has proved to be the most suitable type of reconstruction for...

  • Does systematic 2-field lymphadenectomy for esophageal malignancy offer a survival advantage? Results from 178 consecutive patients. Martin, D. J.; Church, N. G.; Kennedy, C. W.; Falk, G. L. // Diseases of the Esophagus;Oct2008, Vol. 21 Issue 7, p612 

    More extensive resection for esophageal cancer has been reported to improve survival in several series. We compared results from an unselected consecutive cohort of patients undergoing radical esophagectomy, including removal of all periesophageal tissue with a 2-field abdominal and mediastinal...

  • Pyloroplasty in gastric replacement of the esophagus after esophagectomy: one-layer or two-layer technique? Lee, Y.-M.; Law, S.; Chu, K.-M.; Wong, J. // Diseases of the Esophagus;Sep2000, Vol. 13 Issue 3, p203 

    Pyloroplasty is our routine drainage procedure performed when the stomach is used as the esophageal substitute after esophageal resection for cancer. The technique of pyloroplasty varies among surgeons and effectiveness has not been studied. Thirty-four patients with a gastric conduit whose...

  • Ketoconazole and pulmonary failure after esophagectomy: a prospective clinical trial. Schilling, M. K.; Eichenberger, M.; Maurer, C. A.; Sigurdsson, G.; Büchler, M. W. // Diseases of the Esophagus;Spring2001, Vol. 14 Issue 1, p37 

    Thromboxane is a key mediator in pulmonary injury after esophageal resection. In this prospective trial we studied the clinical course and development of pulmonary alterations in patients undergoing esophagectomy and prophylactic treatment with a thromboxane synthase inhibitor. Thirty-eight...

  • Quality-of-life study on four patients who underwent esophageal resection and delayed reconstruction for Boerhaave's syndrome. Varghese, D.; Patel, H.; Waters, R.; Dickson, G.H. // Diseases of the Esophagus;Dec2000, Vol. 13 Issue 4, p314 

    Boerhaave's syndrome is the condition of spontaneous rupture of the esophagus as a consequence of the strain of emesis with or without predisposing esophageal disease. It is a condition with high mortality. We describe four patients who underwent a transthoracic esophagectomy to remove the...

  • High volume centers for esophagectomy: what is the number needed to achieve low postoperative mortality? Metzger, R.; Bollschweiler, E.; Vallböhmer, D.; Maish, M.; DeMeester, T.R.; Hölscher, A. H. // Diseases of the Esophagus;Dec2004, Vol. 17 Issue 4, p310 

    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...

  • Intraoperative recurrent laryngeal nerve monitoring: a useful method for patients with esophageal cancer. Zhong, D.; Zhou, Y.; Li, Y.; Wang, Y.; Zhou, W.; Cheng, Q.; Chen, L.; Zhao, J.; Li, X.; Yan, X. // Diseases of the Esophagus;Jul2014, Vol. 27 Issue 5, p444 

    It is well accepted that recurrent laryngeal nerve paralysis is a severe complication of esophagectomy or lymphadenectomy performed adjacent to the recurrent laryngeal nerves. Herein, determination of the effectiveness of implementing continuous recurrent laryngeal nerve monitoring to reduce the...

  • Esophagectomy via Laparoscopy and Transmediastinal Endodissection. Bonavina, Luigi; Incarbone, Raffaello; Bona, Davide; Peracchia, Alberto // Journal of Laparoendoscopic & Advanced Surgical Techniques;Feb2004, Vol. 14 Issue 1, p13 

    An original technique for minimally invasive transmediastinal esophagectomy is described. A combined laparoscopic and video-mediastinoscopic approach was attempted in a series of patients with high-grade dysplasia or carcinoma of the esophagus. Laparoscopy allowed mobilization of the stomach and...

  • Outcomes from salvage esophagectomy post definitive chemoradiotherapy compared with resection following preoperative neoadjuvant chemoradiotherapy. Smithers, B. M.; Cullinan, M.; Thomas, J. M.; Martin, I.; Barbour, A. P.; Burmeister, B. H.; Harvey, J. A.; Thomson, D. B.; Walpole, E. T.; Gotley, D. C. // Diseases of the Esophagus;Dec2007, Vol. 20 Issue 6, p471 

    Chemoradiotherapy (CRT) as a definitive treatment for esophageal cancer, is being used with increasing frequency and as a result, surgeons will be required to assess more patients who have residual or recurrent local malignancy. This article aimed to assess outcomes after esophagectomy following...

  • Three-field lymph node dissection in the treatment of thoracic esophageal carcinoma: the Turkish experience. Ferahköşe, Z.; Ziya Anadol, A.; Gökbayir, H.; Dursun, A.; Öztürk, E. // Diseases of the Esophagus;Aug2006, Vol. 19 Issue 4, p232 

    The role of extended lymphatic dissection on the prognosis and outcome of thoracic esophageal carcinoma is still controversial. The aim of this study was to determine the impact of three-field lymphatic dissection on the survival and recurrence rates of patients with thoracic carcinoma of the...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics