Improving outcomes after esophagectomy: the impact of operative volume

Once considered an uncommon malignancy, primary esophageal adenocarcinoma has increased steadily in incidence over the past three decades. Despite advances in multimodality therapy, the prognosis for this tumor is generally poor. Surgical resection and reconstruction of the upper gastrointestinal tract is the current standard of care for localized esophageal cancer, but despite advances in perioperative care, still remains a relatively high-risk surgical procedure. Increasing numbers of reports published over the past decade have documented a clear volume-outcome relationship for several complex surgical procedures, and in particular for esophagectomy. The clinical implications of this association are reviewed in this section.