A decade analysis of trends and outcomes of partial versus total esophagectomy in the United States
To examine the trends and outcomes of partial esophagectomy with an intrathoracic anastomosis compared with total esophagectomy with a cervical anastomosis. Controversy exists regarding the optimal surgical approach in the management of esophageal cancer. Using the Nationwide Inpatient Sample databa...
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| Veröffentlicht in: | Annals of surgery 2013-09, Vol.258 (3), p.450-458 |
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| creator | Jafari, Mehraneh D Halabi, Wissam J Smith, Brian R Nguyen, Vinh Q Phelan, Michael J Stamos, Michael J Nguyen, Ninh T |
| description | To examine the trends and outcomes of partial esophagectomy with an intrathoracic anastomosis compared with total esophagectomy with a cervical anastomosis.
Controversy exists regarding the optimal surgical approach in the management of esophageal cancer.
Using the Nationwide Inpatient Sample database, yearly trends of patients with esophageal cancer who underwent partial and total esophagectomy were analyzed. Multivariate logistic regression analysis was used to analyze serious morbidity and in-hospital mortality between partial and total esophagectomy. In addition, outcomes were analyzed according to hospital volume, with low-volume centers defined as those with fewer than 10 cases per year and high-volume centers as those with 10 or more cases per year.
Between 2001 and 2010, 15,190 esophagectomies were performed for cancer. There was an overall increase in the number of esophagectomy procedures performed (1402 to 1975), with a concomitant reduction in the mortality rate (8.3% to 4.2%), particularly for partial esophagectomy. Partial esophagectomy was the predominant operation (76%). Most operations were performed at low-volume centers (62%), with a recent shift of cases to high-volume center. Compared with total esophagectomy, partial esophagectomy was associated with a shorter length of hospital stay (16 ± 6 vs 19 ± 9 days; P < 0.05), a lower in-hospital mortality rate (5.8% vs 8.3%; P < 0.05), and a lower hospital charge ($119,339 vs $138,496; P < 0.05). On multivariate regression analysis, total esophagectomy was associated with higher serious morbidity (odds ratio, 1.39; P < 0.01) and in-hospital mortality (odds ratio, 1.67; P = 0.03). There were no significant differences in risk-adjusted outcomes between low-volume centers and high-volume center.
The number of esophagectomies performed for esophageal cancer has increased over the past decade accompanied by an overall reduction in mortality, particularly for the partial esophagectomy approach. The predominant operation in the United States continues to be partial esophagectomy with an intrathoracic anastomosis, which was associated with lower morbidity and in-hospital mortality than total esophagectomy. Hospital volume at a threshold of 10 cases per year was not a predictor of outcome. |
| doi_str_mv | 10.1097/sla.0b013e3182a1b11d |
| format | Article |
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Controversy exists regarding the optimal surgical approach in the management of esophageal cancer.
Using the Nationwide Inpatient Sample database, yearly trends of patients with esophageal cancer who underwent partial and total esophagectomy were analyzed. Multivariate logistic regression analysis was used to analyze serious morbidity and in-hospital mortality between partial and total esophagectomy. In addition, outcomes were analyzed according to hospital volume, with low-volume centers defined as those with fewer than 10 cases per year and high-volume centers as those with 10 or more cases per year.
Between 2001 and 2010, 15,190 esophagectomies were performed for cancer. There was an overall increase in the number of esophagectomy procedures performed (1402 to 1975), with a concomitant reduction in the mortality rate (8.3% to 4.2%), particularly for partial esophagectomy. Partial esophagectomy was the predominant operation (76%). Most operations were performed at low-volume centers (62%), with a recent shift of cases to high-volume center. Compared with total esophagectomy, partial esophagectomy was associated with a shorter length of hospital stay (16 ± 6 vs 19 ± 9 days; P < 0.05), a lower in-hospital mortality rate (5.8% vs 8.3%; P < 0.05), and a lower hospital charge ($119,339 vs $138,496; P < 0.05). On multivariate regression analysis, total esophagectomy was associated with higher serious morbidity (odds ratio, 1.39; P < 0.01) and in-hospital mortality (odds ratio, 1.67; P = 0.03). There were no significant differences in risk-adjusted outcomes between low-volume centers and high-volume center.
The number of esophagectomies performed for esophageal cancer has increased over the past decade accompanied by an overall reduction in mortality, particularly for the partial esophagectomy approach. The predominant operation in the United States continues to be partial esophagectomy with an intrathoracic anastomosis, which was associated with lower morbidity and in-hospital mortality than total esophagectomy. Hospital volume at a threshold of 10 cases per year was not a predictor of outcome.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/sla.0b013e3182a1b11d</identifier><identifier>PMID: 24022437</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Databases, Factual ; Esophageal Neoplasms - mortality ; Esophageal Neoplasms - surgery ; Esophagectomy - methods ; Esophagectomy - mortality ; Esophagectomy - statistics & numerical data ; Esophagectomy - trends ; Female ; Hospital Mortality ; Hospitals, High-Volume - statistics & numerical data ; Hospitals, High-Volume - trends ; Hospitals, Low-Volume - statistics & numerical data ; Hospitals, Low-Volume - trends ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications - epidemiology ; Treatment Outcome ; United States</subject><ispartof>Annals of surgery, 2013-09, Vol.258 (3), p.450-458</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-817d4c6e3154909dfee3a3146a9586b5630af7aaf7b2d0dc7f89757199b022653</citedby><cites>FETCH-LOGICAL-c419t-817d4c6e3154909dfee3a3146a9586b5630af7aaf7b2d0dc7f89757199b022653</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24022437$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jafari, Mehraneh D</creatorcontrib><creatorcontrib>Halabi, Wissam J</creatorcontrib><creatorcontrib>Smith, Brian R</creatorcontrib><creatorcontrib>Nguyen, Vinh Q</creatorcontrib><creatorcontrib>Phelan, Michael J</creatorcontrib><creatorcontrib>Stamos, Michael J</creatorcontrib><creatorcontrib>Nguyen, Ninh T</creatorcontrib><title>A decade analysis of trends and outcomes of partial versus total esophagectomy in the United States</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>To examine the trends and outcomes of partial esophagectomy with an intrathoracic anastomosis compared with total esophagectomy with a cervical anastomosis.
Controversy exists regarding the optimal surgical approach in the management of esophageal cancer.
Using the Nationwide Inpatient Sample database, yearly trends of patients with esophageal cancer who underwent partial and total esophagectomy were analyzed. Multivariate logistic regression analysis was used to analyze serious morbidity and in-hospital mortality between partial and total esophagectomy. In addition, outcomes were analyzed according to hospital volume, with low-volume centers defined as those with fewer than 10 cases per year and high-volume centers as those with 10 or more cases per year.
Between 2001 and 2010, 15,190 esophagectomies were performed for cancer. There was an overall increase in the number of esophagectomy procedures performed (1402 to 1975), with a concomitant reduction in the mortality rate (8.3% to 4.2%), particularly for partial esophagectomy. Partial esophagectomy was the predominant operation (76%). Most operations were performed at low-volume centers (62%), with a recent shift of cases to high-volume center. Compared with total esophagectomy, partial esophagectomy was associated with a shorter length of hospital stay (16 ± 6 vs 19 ± 9 days; P < 0.05), a lower in-hospital mortality rate (5.8% vs 8.3%; P < 0.05), and a lower hospital charge ($119,339 vs $138,496; P < 0.05). On multivariate regression analysis, total esophagectomy was associated with higher serious morbidity (odds ratio, 1.39; P < 0.01) and in-hospital mortality (odds ratio, 1.67; P = 0.03). There were no significant differences in risk-adjusted outcomes between low-volume centers and high-volume center.
The number of esophagectomies performed for esophageal cancer has increased over the past decade accompanied by an overall reduction in mortality, particularly for the partial esophagectomy approach. The predominant operation in the United States continues to be partial esophagectomy with an intrathoracic anastomosis, which was associated with lower morbidity and in-hospital mortality than total esophagectomy. Hospital volume at a threshold of 10 cases per year was not a predictor of outcome.</description><subject>Aged</subject><subject>Databases, Factual</subject><subject>Esophageal Neoplasms - mortality</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy - methods</subject><subject>Esophagectomy - mortality</subject><subject>Esophagectomy - statistics & numerical data</subject><subject>Esophagectomy - trends</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Hospitals, High-Volume - statistics & numerical data</subject><subject>Hospitals, High-Volume - trends</subject><subject>Hospitals, Low-Volume - statistics & numerical data</subject><subject>Hospitals, Low-Volume - trends</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Postoperative Complications - epidemiology</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUMtOwzAQtBCIlscfIOQjl5Td2InjY1XxkipxAM6RY28gKIlL7CD170mhcOCwWu1oZlYzjF0gLBC0ug6tWUAFKEhgkRqsEN0Bm2OWFgmihEM2BwCRSC3SGTsJ4R0AZQHqmM1SCWkqhZozu-SOrHHETW_abWgC9zWPA_UuTJDjfozWd_QNb8wQG9PyTxrCGHj0cToo-M2beSUbfbflTc_jG_GXvonk-FM0kcIZO6pNG-h8v0_Zy-3N8-o-WT_ePayW68RK1DEpUDlp8ylOJjVoVxMJI1DmRmdFXmW5AFMrM02VOnBW1YVWmUKtqylNnolTdvXjuxn8x0ghll0TLLWt6cmPoUQpUlA784kqf6h28CEMVJeboenMsC0Ryl295dN6Wf6vd5Jd7j-MVUfuT_Tbp_gCAXB3qQ</recordid><startdate>201309</startdate><enddate>201309</enddate><creator>Jafari, Mehraneh D</creator><creator>Halabi, Wissam J</creator><creator>Smith, Brian R</creator><creator>Nguyen, Vinh Q</creator><creator>Phelan, Michael J</creator><creator>Stamos, Michael J</creator><creator>Nguyen, Ninh T</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201309</creationdate><title>A decade analysis of trends and outcomes of partial versus total esophagectomy in the United States</title><author>Jafari, Mehraneh D ; Halabi, Wissam J ; Smith, Brian R ; Nguyen, Vinh Q ; Phelan, Michael J ; Stamos, Michael J ; Nguyen, Ninh T</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-817d4c6e3154909dfee3a3146a9586b5630af7aaf7b2d0dc7f89757199b022653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Databases, Factual</topic><topic>Esophageal Neoplasms - mortality</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy - methods</topic><topic>Esophagectomy - mortality</topic><topic>Esophagectomy - statistics & numerical data</topic><topic>Esophagectomy - trends</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Hospitals, High-Volume - statistics & numerical data</topic><topic>Hospitals, High-Volume - trends</topic><topic>Hospitals, Low-Volume - statistics & numerical data</topic><topic>Hospitals, Low-Volume - trends</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jafari, Mehraneh D</creatorcontrib><creatorcontrib>Halabi, Wissam J</creatorcontrib><creatorcontrib>Smith, Brian R</creatorcontrib><creatorcontrib>Nguyen, Vinh Q</creatorcontrib><creatorcontrib>Phelan, Michael J</creatorcontrib><creatorcontrib>Stamos, Michael J</creatorcontrib><creatorcontrib>Nguyen, Ninh T</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jafari, Mehraneh D</au><au>Halabi, Wissam J</au><au>Smith, Brian R</au><au>Nguyen, Vinh Q</au><au>Phelan, Michael J</au><au>Stamos, Michael J</au><au>Nguyen, Ninh T</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A decade analysis of trends and outcomes of partial versus total esophagectomy in the United States</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2013-09</date><risdate>2013</risdate><volume>258</volume><issue>3</issue><spage>450</spage><epage>458</epage><pages>450-458</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>To examine the trends and outcomes of partial esophagectomy with an intrathoracic anastomosis compared with total esophagectomy with a cervical anastomosis.
Controversy exists regarding the optimal surgical approach in the management of esophageal cancer.
Using the Nationwide Inpatient Sample database, yearly trends of patients with esophageal cancer who underwent partial and total esophagectomy were analyzed. Multivariate logistic regression analysis was used to analyze serious morbidity and in-hospital mortality between partial and total esophagectomy. In addition, outcomes were analyzed according to hospital volume, with low-volume centers defined as those with fewer than 10 cases per year and high-volume centers as those with 10 or more cases per year.
Between 2001 and 2010, 15,190 esophagectomies were performed for cancer. There was an overall increase in the number of esophagectomy procedures performed (1402 to 1975), with a concomitant reduction in the mortality rate (8.3% to 4.2%), particularly for partial esophagectomy. Partial esophagectomy was the predominant operation (76%). Most operations were performed at low-volume centers (62%), with a recent shift of cases to high-volume center. Compared with total esophagectomy, partial esophagectomy was associated with a shorter length of hospital stay (16 ± 6 vs 19 ± 9 days; P < 0.05), a lower in-hospital mortality rate (5.8% vs 8.3%; P < 0.05), and a lower hospital charge ($119,339 vs $138,496; P < 0.05). On multivariate regression analysis, total esophagectomy was associated with higher serious morbidity (odds ratio, 1.39; P < 0.01) and in-hospital mortality (odds ratio, 1.67; P = 0.03). There were no significant differences in risk-adjusted outcomes between low-volume centers and high-volume center.
The number of esophagectomies performed for esophageal cancer has increased over the past decade accompanied by an overall reduction in mortality, particularly for the partial esophagectomy approach. The predominant operation in the United States continues to be partial esophagectomy with an intrathoracic anastomosis, which was associated with lower morbidity and in-hospital mortality than total esophagectomy. Hospital volume at a threshold of 10 cases per year was not a predictor of outcome.</abstract><cop>United States</cop><pmid>24022437</pmid><doi>10.1097/sla.0b013e3182a1b11d</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Annals of surgery, 2013-09, Vol.258 (3), p.450-458 |
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| source | MEDLINE; Journals@Ovid Complete; PubMed Central |
| subjects | Aged Databases, Factual Esophageal Neoplasms - mortality Esophageal Neoplasms - surgery Esophagectomy - methods Esophagectomy - mortality Esophagectomy - statistics & numerical data Esophagectomy - trends Female Hospital Mortality Hospitals, High-Volume - statistics & numerical data Hospitals, High-Volume - trends Hospitals, Low-Volume - statistics & numerical data Hospitals, Low-Volume - trends Humans Logistic Models Male Middle Aged Multivariate Analysis Postoperative Complications - epidemiology Treatment Outcome United States |
| title | A decade analysis of trends and outcomes of partial versus total esophagectomy in the United States |
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