"Performing oesophageal cancer surgery requires a great deal of experience"

[gutlesswonder]

Poster's comment: Before embarking upon treatment patients would be well advised to check their practitioners' track record.

14 Mar 16

The learning curve for surgeons operating on oesophageal cancer is much longer than for other types of surgery, Swedish physicians have found in a study published in the "Journal of Clinical Oncology". A surgeon who operates on oesophageal cancer must have performed 60 operations to prevent any lack of experience adversely affecting the outcome.

It has been known that patient survival after oesophagectomy is very dependent on the surgeon's experience of the procedure. In order to give this dependence concrete numbers, researchers at Karolinska Institutet in Stockholm and at Imperial College London examined a Swedish cohort of 1,821 patients operated on for oesophageal cancer in Sweden between 1987 and 2010 by 139 different surgeons.

They found that, even when surgeons were experienced with other procedures when starting to perform oesophagectomies, a surgeon needs to perform 15 operations to obtain stable survival results during the first months following the operation. The turning point for their learning curves for a stable 5-year fatality rate was even higher, at 60 operations.

"What surprised me was that the learning curve for optimising the long-term prognosis for tumour relapse was so long and the effect so pronounced," said chief investigator Jesper Lagergren at Karolinska Institutet. The form of surgery studied is relatively uncommon, and the new findings indicate that it is worth concentrating oesophageal cancer operations to a small number of surgeons and that properly organised mentorships and training programmes should be introduced.

References

Journal of Clinical Oncology (abstract)

[Rsw1fe]

Very interesting, but not surprising. Practice is so important, as is training of the next cohort. Unfortunately, from what the specialist nurse said to us last week, there is more and more necessity for this operation, given the rising incidence of this cancer.

[Hidden]

Jesper Lagergren is a researcher with a high reputation, and this study does reinforce the move towards fewer, more specialised centres of excellence doing these operations in the UK. It is coinciding with better scanning that finds metastatic spread more effectively, and this process identifies potential operations that would not be viable in the longer term because of the spread. So fewer operations are in fact being carried out, and this is another factor affecting experience of surgeons.

On the plus side, the outcomes are dramatically better than a generation ago when the surgery was performed by surgeons who had personally done very few oesophagectomies.

The outcomes are always more likely to be successful if the cancer is found at an early stage. So awareness and early diagnosis continues to be crucial.

And the other big issue is that regardless of our love and affection for our local surgeons and hospitals / cancer treatment centres, patients will need to travel further afield for their surgery as cancer centres rationalise. The study does indicate that this is for clinical reasons rather than bloody-minded, financially motivated NHS reorganisations (although an element of this can never be ruled out!)