Surgeon volume and postoperative mortality after oesophagectomy for cancer

Oesophagectomy remains the curative treatment of choice for patients with localised oesophageal or cardia cancer, but severe postoperative complications are common. Our aim was to assess the association between surgeon volume and postoperative mortality after oesophagectomy.

Prospective, population-based study of Swedish residents diagnosed with oesophageal or cardia cancer, treated with oesophagectomy during the period April 2001 through December 2005. Details concerning patients, tumours, and surgery were collected from the Swedish Oesophageal and Cardia Cancer register. All 607 patients registered during the study period were included in the study. Risk of mortality 30 and 90 days after oesophagectomy was assessed using multivariable logistic regression, expressed in odds ratios (OR) with 95% confidence intervals (CI), adjusted for relevant covariates.

The 30-day mortality in low-, medium-, and high-volume surgeon groups were 7.1%, 2.1%, and 2.6%, respectively. The corresponding 90-day figures were 11.4%, 4.8%, and 8.9%. Adjusted ORs for 30- and 90-day mortality were decreased non-significantly by 58% and 14%, respectively, among patients in the high-volume group, compared to the low-volume group (OR 0.42, 95% CI 0.10-1.80; OR 0.86, 95% CI 0.31-2.38). The mortality rates differed considerably between individual high-volume surgeons, but without any trend of further decreased risk with increasing volume among these surgeons (p values for trend 0.84 and 0.80 for 30- and 90-day mortality, respectively).

Patients with resectable oesophageal cancer should be advised to choose a high-volume surgeon, but they should also be aware that differences among individual surgeons might further affect survival.