Surgeon Volume and Cancer Esophagectomy, Gastrectomy, and Pancreatectomy: A Population-based Study in England

Mamidanna, Ravikrishna MRCS; Ni, Zhifang MSc, PhD; Anderson, Oliver BSc, MSc, MRCS; Spiegelhalter, Sir David PhD; Bottle, Alex PhD; Aylin, Paul; Faiz, Omar MS, FRCS; Hanna, George B. PhD, FRCS

Annals of Surgery: April 2016 - Volume 263 - Issue 4 - p 727–732

doi: 10.1097/SLA.0000000000001490

Original Articles

Objective: The aim of the study was to assess whether there is a proficiency curve-like relationship between surgeon volume and operative mortality and determine the minimum surgeon volume for optimum operative mortality.

Background: The inverse relationship between hospital volume and operative mortality is well-established for esophageal, gastric, and pancreatic cancer. The recommended minimum surgeon volumes are however uncertain.

Results: Sixteen thousand five hundred seventy-two esophagectomies, 12,622 gastrectomies, and 9116 pancreatectomies were examined. Surgeon volume ranged from 2 to 29 esophagectomies, from 1 to 14 gastrectomies, and from 2 to 31 pancreatectomies per surgeon per year. We demonstrated a proficiency relationship between surgeon volume and mortality in esophageal, gastric, and pancreatic cancer surgery. Each additional case of esophagectomy, gastrectomy, and pancreatectomy would reduce 30-day mortality odds by 3.4%, 7.2%, and 4.1%, respectively. However, as surgeon volume increased, mortality rate continued to improve. Therefore, we were unable to recommend minimum surgeon volume.

Conclusions: Mortality after resections for esophageal, gastric, and pancreatic cancer falls as surgeon volume rises up to 30 cases. Within this range, we did not demonstrate any statistical threshold that could be recommended as a minimum volume target.

http://journals.lww.com/annalsofsurgery/Abstract/2016/04000/Surgeon_Volume_and_Cancer_Esophagectomy,.14.aspx