BACKGROUND: Centralization of esophageal cancer surgery in high-volume centers has been shown to be associated with reduced mortality, length of stay, and improved surgical radicality. However, the effect of hospital volume on long-term survival is unclear. The purpose of this study was to evaluate the long-term survival effects of centralizing esophageal cancer surgery in high-volume centers. METHODS: PubMed, MEDLINE, Scopus, and Web of Science databases were searched through March 15, 2025. Primary outcome was overall survival (OS). High-volume center was defined in case of ≥7 esophagectomy/surgeon/year or ≥10 esophagectomy/center/year or ≥20 esophagectomy/center/year. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. PROSPERO CRD420251026250. RESULTS: Overall, 23,194 patients (9 studies) undergoing esophagectomy for cancer were included. Surgery in high-volume centers was performed 62.4%. Patients' ages ranged from 27 to 79 years, and 86% were males. At 5-year follow-up, the multivariate meta-analysis with RMSTD estimation showed that patients operated in high-volume centers survive 4.3 months more on average compared with patients operated in low-volume centers (95% CI 2.7-5.9; p < 0.001). Compared with surgery in low-volume centers, surgery in high-volume centers was associated with a significantly reduced hazard for mortality up to 60 months (HR 0.65, 95% CI 0.53-0.81). The subgroup analysis based on volume group category (≥10 esophagectomy/center/year and ≥20 esophagectomy/center/year) showed consistent results with the overall analysis suggesting significantly improved 5-year OS for high-volume centers. CONCLUSIONS: Esophagectomy for cancer conducted in high-volume centers seems associated to improved long-term overall survival and reduced mortality hazard within a 5-year follow-up period.
Impact of Centralizing Esophageal Cancer Surgery at High-Volume Centers on Long-Term Survival: Individual Patient Data Meta-Analysis
Bonavina L.
2025-01-01
Abstract
BACKGROUND: Centralization of esophageal cancer surgery in high-volume centers has been shown to be associated with reduced mortality, length of stay, and improved surgical radicality. However, the effect of hospital volume on long-term survival is unclear. The purpose of this study was to evaluate the long-term survival effects of centralizing esophageal cancer surgery in high-volume centers. METHODS: PubMed, MEDLINE, Scopus, and Web of Science databases were searched through March 15, 2025. Primary outcome was overall survival (OS). High-volume center was defined in case of ≥7 esophagectomy/surgeon/year or ≥10 esophagectomy/center/year or ≥20 esophagectomy/center/year. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. PROSPERO CRD420251026250. RESULTS: Overall, 23,194 patients (9 studies) undergoing esophagectomy for cancer were included. Surgery in high-volume centers was performed 62.4%. Patients' ages ranged from 27 to 79 years, and 86% were males. At 5-year follow-up, the multivariate meta-analysis with RMSTD estimation showed that patients operated in high-volume centers survive 4.3 months more on average compared with patients operated in low-volume centers (95% CI 2.7-5.9; p < 0.001). Compared with surgery in low-volume centers, surgery in high-volume centers was associated with a significantly reduced hazard for mortality up to 60 months (HR 0.65, 95% CI 0.53-0.81). The subgroup analysis based on volume group category (≥10 esophagectomy/center/year and ≥20 esophagectomy/center/year) showed consistent results with the overall analysis suggesting significantly improved 5-year OS for high-volume centers. CONCLUSIONS: Esophagectomy for cancer conducted in high-volume centers seems associated to improved long-term overall survival and reduced mortality hazard within a 5-year follow-up period.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
