Outcomes of esophagectomy according to surgeon's training: general vs. thoracic

Esophagectomy is performed by general and thoracic surgeons with the type of operation often dictated by the surgeons' training. The objective was to investigate outcomes of esophagectomy to determine if they varied according to surgeon's training.

Clinical data of patients who underwent partial or total esophagectomy for esophageal cancer from 2003 through 2007 were obtained from the University HealthSystem Consortium database. Data were examined between general versus thoracic surgeon and were reviewed for number and type of operations performed, demographics, length of stay, and postoperative morbidity and mortality.

During the 54-month period, 2,657 esophagectomies were performed; 1,079 (41%) by general surgeons and 1,578 (59%) by thoracic surgeons. More blunt transhiatal esophagectomies were performed by general surgeons compared to thoracic surgeons (56% vs. 37%, p < 0.01) while more Ivor Lewis resections were performed by thoracic surgeons (63% vs. 44%, p < 0.01). Thoracic surgery certification did not significantly affected outcomes with regards to mean hospital and ICU stay, complications, observed mortality, and mortality index.

In academic centers, the majority of esophagectomies for carcinoma are performed by thoracic surgeons who favor the Ivor Lewis approach, while general surgeons favor the blunt transhiatal approach. Despite these differences, specialty training does not appear an important factor affecting outcome.