EFFECT OF SURGICAL EXPERIENCE ON RESULTS OF ESOPHAGECTOMY FOR ESOPHAGEAL-CARCINOMA

Background: Esophagectomy for esophageal cancer is associated with sub stantial operative morbidity and mortality. The effect of surgical exp erience on results of esophagectomy has received little attention in t he medical literature. Methods: A retrospective review of esophagectom ies for cancer was done. Results: Seventy-four patients underwent esop hagectomy by 20 different surgeons. Three surgeons performed 6 or more esophagectomies per year (''frequent'' surgeons), whereas the other 1 7 surgeons performed 5 or fewer esophagectomies per year (''occasional '' surgeons). Forty-two patients were operated on by frequent surgeons . There were 3 (7%) anastomotic leaks and no deaths. In 32 patients op erated on by occasional surgeons, there were 7 (22%) anastomotic leaks and 7 (22%) operative deaths. The anastomotic leak rates were not sig nificantly different (P < .07), but frequent surgeons had a significan tly lower operative mortality (P < .0014). Conclusions: Esophagectomy for esophageal cancer should be performed by experienced esophageal su rgeons with sufficient yearly volume of procedures to maintain compete nce. (C) 1997 Wiley-Liss, Inc.