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Short and Long-term Outcomes Among High-Volume Versus Low-Volume Esophagectomy Surgeons at A High-Volume Center
Seminars in Thoracic and Cardiovascular Surgery  (IF2.006),  Pub Date : 2021-09-21, DOI: 10.1053/j.semtcvs.2021.09.007
Daniel Dolan, Abby White, Daniel N. Lee, Emanuele Mazzola, Emily Polhemus, Suden Kucukak, Jon O Wee, Scott J Swanson

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-August 2019 were reviewed. Cases were divided by surgeon into low, <7 cases/year, versus 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 versus 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% versus 14.5%, p<0.01. Low-volume surgeons had more complications than high-volume surgeons (71.7% versus 57.6%, p<0.01), specifically Grade II and III (59.2% versus 46.8%, p=0.01, and 44.2% versus 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 versus 49.3% high-volume, p=0.64), or 5-year disease-free survival (35.7% low-volume versus 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.