Patients who undergo surgery for oesophageal cancer have a much greater chance of long-term survival if the operation is carried out by a surgeon who has performed it many times before, according to a large-scale study conducted by researchers at Karolinska Institutet in Sweden.
The study, published in the Journal of Clinical Oncology, included all 1,335 patients operated on for oesophageal cancer in Sweden between 1987 and 2005 – with follow-ups up to January 2011. Survival analysis was used to study the effect of annual hospital volume, annual surgeon volume and surgeon experience. The analyses were adjusted for all established prognostic factors. The study’s main finding was that patients operated on by surgeons with a high annual and total volume had 22% lower long-term mortality than patients operated on by surgeons with a low annual and total operation volume. The hospital’s annual volume, however, had no independent impact on long-term survival. From this, the researchers concluded that oesophageal cancer surgery should be concentrated to fewer surgeons, giving them the opportunity to maintain a high annual volume for this major, complicated procedure.
