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No Influence of Surgical Volume on Patients’ Health-Related Quality of Life After Esophageal Cancer Resection

¹ Department of Molecular Medicine and Surgery, Unit of Esophageal and Gastric Research (ESOGAR), Karolinska Institutet, Stockholm, Sweden
² Department of Surgery, P9:03, Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden

Correspondence: Address correspondence and reprint requests to: Martin Rutegård; E-mail: martin.rutegard{at}ki.se

Background: Studies on factors that can counteract the negative impact of esophagectomy on patients’ health-related quality of life (HRQL) have been sparse. This study was undertaken to examine the question whether hospital or surgeon volume influences HRQL as evaluated 6 months after such surgery.

Materials and Methods: A Swedish prospective, population-based cohort study of esophageal cancer patients treated surgically in 2001–2005 was conducted. All patients completed validated HRQL questionnaires, developed by EORTC, addressing general HRQL (QLQ-C30) and esophageal-specific symptoms (QLQ-OES18), 6 months postoperatively. Mean scores with 95% confidence intervals were calculated. Clinically relevant mean score differences (10) between groups were further analyzed in a linear regression model, adjusted for several potential confounders.

Results: Some 355 patients were included (80% of eligible). No clinically relevant differences were found between low-volume (0–9 operations/year) and high-volume hospitals (>9 operations/year) or between low-volume (0–6 operations/year) and high-volume surgeons (>6 operations/year). Stratified analyses for tumor location did not reveal any differences between hospital or surgeon volume groups. Moreover, no material differences were found between the four individual high-volume hospitals.

Conclusion: This study revealed no HRQL advantages of being treated at high-volume hospitals or by high-volume surgeons, as measured 6 months after esophageal cancer resection.

Key Words: Esophagectomy • Cardia cancer • Questionnaires • EORTC • QLQ-C30 • QLQ-OES18