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Background <p>Esophageal cancer is a significant health burden in China, commonly treated by esophagectomy, a procedure with considerable risks. While higher hospital volume is associated with improved outcomes in Western countries, it remains unclear if this volume-outcome relationship persists in China, where many centers handle a relatively high caseload compared to Western standards. This study investigated the impact of hospital volume on perioperative morbidity and long-term survival outcomes following esophagectomy for esophageal cancer within the context of Chinese medical centers.</p> Methods <p>This study analyzed data from a prospective multicenter database (April 2015—December 2018) including 6775 patients with clinical stage cT1b-3N0-1M0 esophageal cancer undergoing radical esophagectomy across 19 Chinese centers. Centers were categorized based on procedural volume over 3.5&#xa0;years: Group A (high-volume: ≥ 400 cases) and Group B (low-volume: &lt; 400 cases). Perioperative complications and 5-year overall survival (OS) and disease-free survival (DFS) were compared. Propensity score matching (PSM) was employed to balance baseline characteristics between groups.</p> Results <p>Analysis included 6,125 patients (4,633 Group A, 1,492 Group B) for survival outcomes. Group B demonstrated significantly higher rates of total complications (23% vs 19%, P &lt; 0.001), including anastomotic leakage (5.9% vs 4.5%, P = 0.014), cardiovascular events (2.0% vs 0.9%, P &lt; 0.001), and recurrent laryngeal nerve paralysis (12.1% vs 10.0%, P = 0.033), alongside longer mean operation times (P &lt; 0.001). After PSM (1,492 matched pairs), Group A maintained superior 5-year OS (49% vs 45%, P &lt; 0.05, HR: 1.12, 95%CI, 1.01–1.23) and 5-year DFS (45% vs 42%, P &lt; 0.05, HR: 1.14, 95%CI, 1.03–1.25) compared to Group B.</p> Conclusions <p>Hospital volume significantly influenced esophagectomy outcomes in China, even among centers with relatively high caseloads. Treatment at high-volume centers was associated with lower postoperative morbidity and better long-term survival for patients with esophageal cancer.</p>

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Impact of hospital volume on outcomes of esophagectomy for esophageal cancer: analysis of a prospective multicenter database

  • 期刊论文

  • 发表日期：

    2025年12月23日

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  • You-sheng Mao,
  • Shu-geng Gao,
  • Fu-shun Guan,
  • Yin Li,
  • Xiang-ning Fu,
  • Xiao-fei Li,
  • An-lin Hao,
  • Jun-feng Liu,
  • Jian-qun Ma,
  • Wen-jun Gao,
  • Qing-chen Wu,
  • Long-qi Chen,
  • Jian-hua Fu,
  • Yue-jun Chen,
  • Mei-qing Xu,
  • Kang Zhang,
  • Ren-quan Zhang,
  • Wen-tao Fang,
  • Zhi-gang Li,
  • Wei-min Mao,
  • Wei-ping Lu,
  • Zhen-tao Yu,
  • Li-gong Yuan,
  • Dong-hui Jin,
  • Hang Yi,
  • Yan Fang,
  • Dong-hong Fu,
  • Xu-dong Wei,
  • Jie He

摘要

Background

Esophageal cancer is a significant health burden in China, commonly treated by esophagectomy, a procedure with considerable risks. While higher hospital volume is associated with improved outcomes in Western countries, it remains unclear if this volume-outcome relationship persists in China, where many centers handle a relatively high caseload compared to Western standards. This study investigated the impact of hospital volume on perioperative morbidity and long-term survival outcomes following esophagectomy for esophageal cancer within the context of Chinese medical centers.

Methods

This study analyzed data from a prospective multicenter database (April 2015—December 2018) including 6775 patients with clinical stage cT1b-3N0-1M0 esophageal cancer undergoing radical esophagectomy across 19 Chinese centers. Centers were categorized based on procedural volume over 3.5 years: Group A (high-volume: ≥ 400 cases) and Group B (low-volume: < 400 cases). Perioperative complications and 5-year overall survival (OS) and disease-free survival (DFS) were compared. Propensity score matching (PSM) was employed to balance baseline characteristics between groups.

Results

Analysis included 6,125 patients (4,633 Group A, 1,492 Group B) for survival outcomes. Group B demonstrated significantly higher rates of total complications (23% vs 19%, P < 0.001), including anastomotic leakage (5.9% vs 4.5%, P = 0.014), cardiovascular events (2.0% vs 0.9%, P < 0.001), and recurrent laryngeal nerve paralysis (12.1% vs 10.0%, P = 0.033), alongside longer mean operation times (P < 0.001). After PSM (1,492 matched pairs), Group A maintained superior 5-year OS (49% vs 45%, P < 0.05, HR: 1.12, 95%CI, 1.01–1.23) and 5-year DFS (45% vs 42%, P < 0.05, HR: 1.14, 95%CI, 1.03–1.25) compared to Group B.

Conclusions

Hospital volume significantly influenced esophagectomy outcomes in China, even among centers with relatively high caseloads. Treatment at high-volume centers was associated with lower postoperative morbidity and better long-term survival for patients with esophageal cancer.