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Influence of facility volume on long-term survival of patients undergoing esophagectomy for esophageal cancer.

Patel DC, Jeffrey Yang CF, He H, Liou DZ, Backhus LM, Lui NS, Shrager JB, Berry MF. Influence of facility volume on long-term survival of patients undergoing esophagectomy for esophageal cancer. The Journal of Thoracic and Cardiovascular Surgery. 2022 Apr 1; 163(4):1536-1546.e3.

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Abstract:

OBJECTIVE: This study investigated the influence of facility volume on long-term survival in patients with esophageal cancer treated with esophagectomy. METHODS: Patients treated with esophagectomy for cT1 3N0 3M0 adenocarcinoma or squamous cell carcinoma of the mid-distal esophagus in the National Cancer Database between 2006 and 2013 were stratified by annual facility esophagectomy volume dichotomized as more/less than both 6 and 20. Patient characteristics associated with facility volume were evaluated using logistic regression, and the influence of facility volume on survival was evaluated with Kaplan-Meier curves, Cox proportional hazards methods, and propensity matched analysis. RESULTS: Of 11,739 patients who had esophagectomy at 1018 facilities where annual volume ranged from 1 to 47.6 cases, 4262 (36.3%) were treated at 44 facilities with annual esophagectomy volume  >  6 and 1515 (12.9%) were treated at 7 facilities with annual volume  >  20. Higher volume was associated with significantly better 5-year survival for both annual volume > 6 (47.6% vs 40.2%; P  <  .001) and annual volume  >  20 (47.2% vs 42.3%; P  <  .001), which persisted in propensity matched analyses as well as Cox multivariable analysis (hazard ratio, 0.81; 95% confidence interval, 0.74-0.89; P  <  .001 for facility volume  >  6 and hazard ratio, 0.78; 95% confidence interval, 0.65-0.95; P  =  .01 for facility volume  >  20). In Cox multivariable analysis that considered facility volume as a continuous variable, higher volume continued to be associated with better survival (hazard ratio, 0.93 per 5 cases; 95% CI, 0.91-0.96; P  <  .001). CONCLUSIONS: Esophageal cancer patients treated with esophagectomy at higher volume facilities have significantly better long-term survival than patients treated at lower volume facilities.





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