The following is a summary of “Effect of Center Esophagectomy Volume on Outcomes in Clinical Stage I to III Esophageal Cancer,” published in the July 2023 issue of Surgery by Rhodin et al.
To ascertain the optimal annualized esophagectomy volume threshold that correlates with enhanced survival rates, successful oncologic resection, and improved postoperative outcomes. Esophagectomy performed at medical facilities with a high patient caseload is associated with enhanced medical results; nevertheless, there is ongoing discussion regarding the precise criteria for defining high-volume centers. The National Cancer Database from 2004 to 2016 was examined to identify individuals diagnosed with clinical stage I to III esophageal cancer who underwent esophagectomy. The volume of center esophagectomy was modeled as a continuous variable using restricted cubic splines in the medical context. Maximally selected ranks were employed to ascertain an inflection point about the volume of the central region and its impact on survival.
Survival outcomes were evaluated through the utilization of multivariable Cox proportional hazards methods. Multivariable logistic regression was employed to analyze secondary medical developments. In total, a cohort of 13,493 patients fulfilled the inclusion criteria for the study. The median center esophagectomy volume was 8.2 (interquartile range: 3.2–17.2) cases per annum. Inflection points were identified at 9 and 30 yearly issues on restricted cubic splines. A multivariable Cox model was developed, incorporating annualized center surgical volume as a continuous variable. The model utilized three linear splines with inflection points at 9 and 30 cases per year. In the context of multivariable analysis, it was observed that there was a significant improvement in survival rates (hazard ratio: 0.97, 95% CI, 0.95–0.98, P≤0.001) when the volume of cases at a medical center increased up to 9 issues per year.
In the context of multivariable logistic regression, it was observed that several factors were significantly associated with the likelihood of undergoing surgery at a high-volume medical facility, defined as centers performing more than 9 cases per year. These factors included having private insurance coverage, receiving care at an academic center, completing high school education, and residing far from the medical facility. This study, conducted using the National Cancer Database and employing multivariable analysis and restricted cubic splines, indicates that a high-volume esophagectomy center can be defined as a facility carrying a minimum of 10 operations per year.