The Volume-Outcome Relationship After Esophagectomy From a Quality Collaborative

Document Type

Conference Proceeding

Publication Date

8-2025

Publication Title

Diseases of the Esophagus

Abstract

Background: Esophageal cancer resections are complex procedures associated with significant risks, contributing to increased morbidity, mortality, and prolonged hospital stays. Anastomotic leak rates vary by surgical approach and can have a profound impact on both short- and long-term clinical outcomes. The impact of anastomotic leaks may differ based on surgical technique, leak location, and institutional experience. This study examines how anastomotic leaks, stratified by hospital volume and surgical approach, influence complication rates and recovery times. Methods: This study retrospectively analyzed prospectively collected data on patients who underwent an esophagectomy for esophageal cancer between January 2014 and March 2023 across 13 centers participating in a statewide quality collaborative. Hospital volume was categorized as low (< 5/year), medium (5–20/year), or high (>20/year). Seven centers were classified as low-volume centers (LVC), five as medium-volume centers (MVC), and one as a high-volume center (HVC). Anastomotic leaks and other postoperative complications were assessed in relation to hospital volume and surgical approach. Statistical analyses included both parametric and non-parametric tests, applied as appropriate. Results: A total of 1401 esophagectomy patients were reviewed, with 88 at LVC, 558 at MVC, and 755 at HVC. Ivor Lewis esophagectomy (ILE) was more common at LVC (66%) and MVC (65%), while transhiatal esophagectomy (THE) predominated at the HVC (81%), p < 0.001. Robotic-assisted esophagectomy was least frequent at LVC (15%) compared to MVC (46%) and HVC (41%), p < 0.001. While leak rates in ILE and THE were not significantly different across hospital volumes, hospital volume significantly impacted length of stay for THE leaks, with MVC patients staying 17 days longer than HVC (CI: 9–23), Table. Conclusion: Surgical approach varied by hospital volume, with ILE being more common at LVC and MVC, while THE was predominant at the HVC. Differences in robotic-assisted techniques further emphasize institutional variations. Despite these differences, anastomotic leak rates were comparable across hospital volumes. However, following a THE leak, hospitalization was significantly prolonged at MVC and HVC experienced a higher rate of unexpected intensive care unit transfers. Additionally, LVC had a higher incidence of postoperative arrhythmia, sepsis, and in-hospital mortality following a ILE leak. These findings highlight potential areas for quality improvement.

Volume

38

Issue

Suppl 1

First Page

82

Last Page

82

Comments

21st ISDE (International Society for Diseases of the Esophagus) World Congress for Esophageal Diseases, September 18-20, 2025, Brisbane, Australia

DOI

10.1093/dote/doaf061.225

Link to Full Text

Share

COinS