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.
Journal of Clinical Oncology (abstract)