Surgical Proficiency Gains in Esophagectomy for Cancer Improve Survival

Gains in surgical proficiency in esophagectomy for cancer are associated with measurable improvements in short-term and long-term mortality results.
Gains in surgical proficiency in esophagectomy for cancer are associated with measurable improvements in short-term and long-term mortality results.

Gains in surgical proficiency in esophagectomy for cancer are associated with measurable improvements in short-term and long-term mortality results, a study published online ahead of print in the Journal of Clinical Oncology has shown.1

For this study, the researchers sought to identify the impact of surgeon proficiency in esophagectomy on short-term and long-term mortality for patients with esophageal cancer.

The researchers identified 1821 patients with esophageal cancer who underwent esophagectomy between 1987 and 2010 with follow-up until 2014 from a well-established, population-based nationwide Swedish cohort study. The procedures were conducted by 139 surgeons.

Risk-adjusted cumulative sum analysis for 30-day, 90-day, 1-year, 3-year, and 5-year all-cause and disease-specific mortality measures were used to create proficiency gain curves. The researchers assessed proficiency gain curves for lymph node harvest, resection margin status, and reoperation incidence as performance-contributing factors to the changes seen in long-term survival.

At a change-point in proficiency gain curve of 15 cases, all-cause mortality decreased from 7.9% to 3.1% (P<.001). Reductions in all-cause mortality were seen at 1 year from 34.9% to 27.7% (P=.011), at 3 years from 47.4% to 41.5% (P=.049), and at 5 years from 31.4% to 19.1% (P=.009), with change-points ranging from 35 to 59 cases.

At 1 and 3 years, change-points for disease-specific mortality were similar. A continuous increase in lymph node harvest was observed, which did not plateau. In addition, change-points for resection margin with tumor involvement were observed at 17 cases (a decrease from 20.9% to 15.2% [P=.004]) and for reoperation rate at 55 cases (a decrease from 12.6% to 5.0% [P<.001]).

The researchers conclude their findings “indicate a need for structured national training and mentorship programs for esophageal cancer surgery.”

REFERENCE

1. Markar SR, Mackenzie H, Lagergren P, Hanna GB, Lagergren J. Surgical proficiency gain and survival after esophagectomy for cancer [published online ahead of print March 7, 2016]. J Clin Oncol. doi:10.1200/JCO.2015.65.2875.

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