Factors Affecting Esophageal Cancer Treatment Outcomes
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The 5-year survival rate for esophageal cancer is poor, between 15-30% depending on factors like early detection and treatment quality. Studies show that higher hospital and surgeon volume (more than 20 and 6 esophagectomies per year respectively) are associated with lower mortality rates and better outcomes. A Dutch study concentrated esophageal cancer surgeries across 3 high-volume hospitals and saw improved 2-year survival rates, demonstrating that centralization based on both volume and monitored outcomes can enhance quality. National auditing programs may help further progress.
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Factors Affecting Esophageal Cancer Treatment Outcomes
- 1. Centralization of Esophageal Cancer Treatment Peter D. Siersema Dept. of Gastroenterology and Hepatology
- 5. Outcome of esophagectomy Practice makes perfect …..
- 12. Dutch guidelines on esophageal cancer (2005)
- 13. Dutch guidelines on esophageal cancer (2005) “ At least 10 times per year” “ Inspection of Healthcare” “ Quality of esophageal cancer resection requires experience”
- 14. High-volume vs. Low-volume Literature Gruen et al. CA Cancer J Clin 2009; 59: 192-211 1 1 2 1 6 28 Studies Short- term Long-term Short- term Long-term Short-/Long-term 1 0 Hospital volume Quality of life 0 1 Hospital specialization 1 1 Hospital volume Survival 0 6 0 16 2 1 Surgeon volume 0 2 Surgeon volume 9 4 Hospital volume In-hospital mortality Results S NS Level Outcome
- 15. High-volume vs. Low-volume Literature Gruen et al. CA Cancer J Clin 2009; 59: 192-211 1 1 2 1 6 28 Studies Short- term Long-term Short- term Long-term Short-/Long-term 1 0 Hospital volume Quality of life 0 1 Hospital specialization 1 1 Hospital volume Survival 0 6 0 16 2 1 Surgeon volume 0 2 Surgeon volume 9 4 Hospital volume In-hospital mortality Results S NS Level Outcome
- 16. High-volume vs. Low-volume Literature Gruen et al. CA Cancer J Clin 2009; 59: 192-211
- 17. High-volume vs. Low-volume Literature Gruen et al. CA Cancer J Clin 2009; 59: 192-211
- 18. High-volume vs. Low-volume Literature Gruen et al. CA Cancer J Clin 2009; 59: 192-211
- 20. Volume or Outcome? Esophagectomies in NL Data-source: PRISMANT 1990-2004
- 21. Volume or Outcome? Esophagectomies in NL Data-source: PRISMANT 1990-2004 Volume?
- 22. Volume or Outcome? Esophagectomies in NL Data-source: PRISMANT 1990-2004 Outcome?
- 23. Volume or Outcome? Esophagectomies in NL Data-source: PRISMANT 1990-2004 Outcome?
- 25. Concentration of Esophagectomy Results: Treatment Outcome Wouters et al. Surg Oncol 2009; 16: 1789-98
- 26. Concentration of Esophagectomy Results: 2-years survival Log-rank P =0.03 52% (2000-2005) 43% (1995-1999) 38% (1990-1994) Log rank: p2 vs p3: p =0.01 p1 vs p3: p <0.001 p1 vs p2: p =0.34 p3 p2 p2 p1 Wouters et al. Surg Oncol 2009; 16: 1789-98
Notas del editor
- One of the procedures showing a strong volume-outcome relationship are esophageal resections for cancer.
- One of the procedures showing a strong volume-outcome relationship are esophageal resections for cancer.
- One of the procedures showing a strong volume-outcome relationship are esophageal resections for cancer.
- One of the procedures showing a strong volume-outcome relationship are esophageal resections for cancer.
- One of the procedures showing a strong volume-outcome relationship are esophageal resections for cancer.
- An example in regard to the last point: Esophageal resections for cancer, are high-risk surgical procedures for which strong variation in outcome is demonstrated between low and high volume hospitals....also in our country. In this funnel-plot based on data from the National In-Patient Registry (PRISMANT), we see all hospitals performing esophageal resections in a 15 years period, presented as small dots. On the lower right, there are 2 or 3 high-volume centers, performing more than 20 resections a year with a mortality rate of approximately 5%. To the left the other 90 hospitals are in a big low-volume cloud, with an enormous variation in mortality (in some hospitals more than 1 in 4 patients died post operatively).
- An example in regard to the last point: Esophageal resections for cancer, are high-risk surgical procedures for which strong variation in outcome is demonstrated between low and high volume hospitals....also in our country. In this funnel-plot based on data from the National In-Patient Registry (PRISMANT), we see all hospitals performing esophageal resections in a 15 years period, presented as small dots. On the lower right, there are 2 or 3 high-volume centers, performing more than 20 resections a year with a mortality rate of approximately 5%. To the left the other 90 hospitals are in a big low-volume cloud, with an enormous variation in mortality (in some hospitals more than 1 in 4 patients died post operatively).
- An example in regard to the last point: Esophageal resections for cancer, are high-risk surgical procedures for which strong variation in outcome is demonstrated between low and high volume hospitals....also in our country. In this funnel-plot based on data from the National In-Patient Registry (PRISMANT), we see all hospitals performing esophageal resections in a 15 years period, presented as small dots. On the lower right, there are 2 or 3 high-volume centers, performing more than 20 resections a year with a mortality rate of approximately 5%. To the left the other 90 hospitals are in a big low-volume cloud, with an enormous variation in mortality (in some hospitals more than 1 in 4 patients died post operatively).
- An example in regard to the last point: Esophageal resections for cancer, are high-risk surgical procedures for which strong variation in outcome is demonstrated between low and high volume hospitals....also in our country. In this funnel-plot based on data from the National In-Patient Registry (PRISMANT), we see all hospitals performing esophageal resections in a 15 years period, presented as small dots. On the lower right, there are 2 or 3 high-volume centers, performing more than 20 resections a year with a mortality rate of approximately 5%. To the left the other 90 hospitals are in a big low-volume cloud, with an enormous variation in mortality (in some hospitals more than 1 in 4 patients died post operatively).
- Probably most of you have heard about the centralization project in the region of the Comprehensive Cancer Center Leiden... In 2000 none of the 11 hospitals performed more than 7 esophagectomies a year. Because of the growing evidence for a volume-outcome relation for esophageal cancer surgery in the literature,... the surgical oncologists decided to audit the quality of care in the region. 10 years retrospective data were retrieved from all hospitals .........and remarkable differences in outcome were revealed. This led to the concentration of procedures in 3 hospitals, based on their observed outcome. The audit was continued to monitor the effects of this outcome-based centralization from the year 2000 untill now. Not only for esophageal resections..., but also pancreatic, liver and soft tissue resections.
- In this table we see the updated outcome data....There was a dramtic fall in hospital mortality from 12% in the 1995-1999 period to 4% in the 2000-2004 period. This was accompanied with a significant reduction in hospital stay and tumor-free margins.
- Also, a significant improvement in survival was observed in the last 5-years episode ( marked with p3 ...for period three...in this figure).