Swedish Study Shows Association of Survival Gain With Increased Surgeon Experience in Patients Undergoing Esophagectomy for Cancer


Key Points

  • Increased surgeon experience was associated with improved short-term and long-term survival in patients undergoing esophagectomy for esophageal cancer.
  • Increased surgeon experience was associated with an increased lymph node harvest, reduced margins with tumor, and reduced reoperation.

Increased surgeon experience was associated with markedly better short- and long-term survival in patients undergoing esophagectomy for esophageal cancer, according to a report by Markar et al in the Journal of Clinical Oncology.

Study Details

The study involved data from 1,821 patients who underwent esophagectomy between 1987 and 2010 with follow-up until 2014 from a population-based nationwide Swedish cohort study. Procedures were performed by 139 surgeons.

Change Points for Survival

The change point in the proficiency gain curve for all-cause 30-day mortality occurred at 15 cases, with a decrease in mortality from 7.9% to 3.1% (P < .001). At 22 cases, 90-day all-cause mortality decreased from 7.3% to 5.2% (P = .079). At 53 cases, 1-year mortality was reduced from 34.9% to 27.7% (P = .011); 3-year mortality was reduced from 47.4% to 41.5% (P = .049) at 35 cases, and 5-year mortality from 31.4% to 19.1% (P = .006) at 59 cases. Similar change points were observed in disease-specific mortality at 1 and 3 years.

An increasing number of cases were associated with a continuous increase in lymph node harvest, with no plateau. A change point of 17 cases was found for resection margin with tumor, with a reduction from 20.9% to 15.2% (P = .004). A change point of 55 cases was found for reoperation, with a reduction from 12.6% to 5.0% (P < .001).

The investigators concluded: “The gain of proficiency in esophagectomy for cancer is associated with measurable changes in short- and long-term mortality results. These findings indicate a need for structured national training and mentorship programs for esophageal cancer surgery.”

The study was funded by the Swedish Research Council, the Swedish Cancer Society, and the National Institutes of Health Research.

Jesper Lagergren, PhD, of Karolinska Institutet, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.