What type of study is this?

This is a Prospective study (also classified as: Multicenter).

September 10, 2025

Impact of Hospital Volume on Outcomes of Esophagectomy for Esophageal Cancer: Analysis of a Prospective Multicenter Database

YMYousheng MaoChinese Academy of Medical Sciences & Peking Union Medical College SGShugeng GaoJohnson & Johnson (United States)FGFu-shun GuanLinzhou Cancer Hospital

Key Points

Higher hospital volume is linked to significantly better overall survival rates after esophagectomy for esophageal cancer.
Patients in high-volume centers had lower complication rates, including less anastomotic leakage and cardiovascular events.
Operation times were shorter in high-volume centers, suggesting more efficient surgical processes.
Emphasizing the need for centralized care, this research underlines the advantages of expert surgical teams in managing esophageal cancer.

Abstract

Abstract Background Hospital volume has long been recognized as a critical determinant of surgical outcomes. In the context of esophageal cancer, hospital volume influences morbidity, mortality, and survival after esophagectomy. While previous studies in Western countries have highlighted the volume-outcome relationship, the impact of hospital volume on esophagectomy outcomes in high-volume centers, especially in China, remains unclear. This study aimed to investigate whether hospital volume still influences surgical outcomes in Chinese institutions with relatively higher surgical volumes. Methods This prospective, multicenter study analyzed data from 6775 patients diagnosed with thoracic esophageal cancer (clinical stage cT1b-3 N0–1M0) who underwent radical esophagectomy between April 2015 and December 2018. Patients were divided into two groups based on hospital volume: Group A (≥400 esophagectomies over 3.5 years) and Group B (400 esophagectomies). Perioperative complications, 5-year overall survival (OS), and disease-free survival (DFS) were compared between the groups. Statistical analyses were performed using SPSS version 19.0 and R version 3.6.2. Results Of the 6775 patients, 4633 were from high-volume centers (Group A), and 1492 were from low-volume centers (Group B). Group B showed significantly higher complication rates (23% vs. 19%, P 0.001), including anastomotic leakage, cardiovascular events, and recurrent laryngeal nerve paralysis. Group A also had shorter operation times (210 min vs. 240 min, P 0.001). Before propensity score matching (PSM), the 5-year OS in Group A was 51% versus 45% in Group B (P 0.05), and DFS was 47% vs. 42% (P 0.05). After PSM, Group A maintained superior outcomes in both OS and DFS. Conclusion Hospital volume remains a significant factor influencing the outcomes of esophagectomy for esophageal cancer. High-volume centers demonstrate lower complication rates and better long-term survival, emphasizing the need for centralized care and expert surgical teams in the management of esophageal cancer in China.

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