Centralizing Esophagectomy to Improve Outcomes and Enhance Clinical Research: Invited Expert Review

Since the 1970s, studies have demonstrated a strong association between operative volume and outcomes such as death and complications, particularly for complex cancer resections such as esophagectomy. The denouement has been to suggest that this operation should be directed toward specialized centers of esophageal cancer care, with operative volume thresholds being the primary basis for evidence-based hospital referral. This article reviews early efforts to centralize esophagectomy, as reported from other countries such as England, Canada, and the Netherlands, as well as the potential effect on access to care from instituting such policies in the United States.