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A surgeon's case volume of oesophagectomy for cancer does not influence patient outcome in a high volume hospital

^a Department of Cardiothoracic Surgery, Ground Floor West Wing, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK
^b Centre for Clinical and Population Sciences, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK
^c Northern Ireland Cancer Registry, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK

*Corresponding author. Tel.: +44-2890-632077/+44-2890-632027; fax: +44-2890-633937.

E-mail address: reubenj{at}hotmail.com (R. Jeganathan).

The aim of this study is to assess if individual case volume of oesophageal resections influences the operative mortality rate in a high volume hospital. Between June 1994 and June 2006, 252 total thoracic oesophageal resections (75% male, mean age 63 years) were performed by five surgeons in tertiary referral centre. Operative approach was standardised in all cases and consisted of left thoracolaparotomy, resection of all intrathoracic and abdominal oesophagus and left cervical incision for anastomosis. Operative mortality, defined as in-hospital death irrespective of length of stay, was compared among consultants and also trainees. A total of 207 operations were performed by five consultants with nine deaths (4.3%) compared to two deaths after 45 operations by 17 trainees (4.4%) [Fisher's exact test, P=0.61 (CI=0.84–1.26)]. Individual case volume for consultants ranged from 5 to 10.5 cases/years [²-test, P=0.34 (CI=0.89–1.29)] with 0–5.4% mortality rate [²-test, P=0.24 (CI=0.96–1.19)]. Overall hospital volume ranged from 17 to 57 cases/years. This study confirms that surgeons with appropriate training in oesophageal resection may get good results despite lower individual case volumes when a standardised approach is taken in an institution with a high case volume.

Key Words: Oesophagectomy; Mortality; Hospital volume; Survival