Surgical skill increases survival for oesophageal cancer surgery

Resection of the oesophagus for cancer should no longer be an operation with a high mortality rate provided experienced surgeons are involved as part of a multidisciplinary team”, according to Mr Subhajit Dutta Roy, Clinical Research Fellow at the Surgical Research Unit, Leighton Hospital, Crewe in the United Kingdom. Mr Dutta Roy was speaking at the 12th Congress of the European Society of Surgical Oncology in Budapest.

Oesophageal cancer is closely associated with alcohol consumption and tobacco smoking. The UK has one of the highest incidences of oesophageal cancer in Europe and each year there are around 4,200 deaths from the disease[1].

The mainstay of treatment for oesophageal cancer is surgery to remove the oesophagus, a procedure known as ‘oesophagectomy’. However, the procedure is known for having a relatively high mortality rate.

Mr Dutta Roy and his colleagues used the Hospital Episodes Statistics database to examine the outcome of 6,950 oesophagectomies in England over a four year period from 1997 – 2001. They found that in those hospitals with high oesophagectomy case-loads there was a corresponding, and statistically significant, improvement in operative survival. Mr Dutta Roy acknowledged that in-hospital mortality can arise from a number of factors, and assessing outcome measures for all types of complex surgical procedures is inherently difficult. “However, the statistics show a clear survival benefit where experienced surgeons perform the procedure”, he added.

These results mirror those found in other studies and further suggest that surgical skill is a major factor in successful outcome of surgical procedures for a range of cancers, and may also suggest a potential beneficial effect of centralization of oesophageal cancer surgery in England.

There are currently no specialist oesophageal centers in the UK and Mr Dutta Roy cautions against steps to develop them on the basis of these results alone. “Centralizing the resources for one specific procedure in a specialist center may, in fact, make matters worse as better results from high volume centres lack specificity and may be due to inherent structures and processes in place in ‘bigger’ hospitals”. “It would make more sense to develop specialized, regional centers for all complex surgical procedures”, said Mr Dutta Roy.

[1] Data obtained from the Globocan 2000 report – available through the International Agency for Research on Cancer (IARC) website