Regionalization of esophagectomy: Where are we now?

James M. Clark, Daniel J. Boffa, Robert A. Meguid, Lisa M. Brown, David T. Cooke

Research output: Contribution to journalReview article

Abstract

The morbidity and mortality benefits of performing high-risk operations in high-volume centers by high-volume surgeons are evident. Regionalization is a proposed strategy to leverage high-volume centers for esophagectomy to improve quality outcomes. Internationally, regionalization occurs under national mandates. Those mandates do not exist in the United States and spontaneous regionalization of esophagectomy has only modestly occurred in the U.S. Regionalization must strike a careful balance and not limit access to optimal oncologic care to our most vulnerable cancer patient populations in rural and disadvantaged socioeconomic areas. We reviewed the recent literature highlighting: the justification of hospital and surgeon annual esophagectomy volumes for regionalization; how safety performance metrics could influence regionalization; whether regionalization is occurring in the US; what impact regionalization may have on esophagectomy costs; and barriers to patients traveling to receive oncologic treatment at regionalized centers of excellence.

Original languageEnglish (US)
Pages (from-to)S1633-S1642
JournalJournal of Thoracic Disease
Volume11
DOIs
StatePublished - Jan 1 2019

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Esophagectomy
Vulnerable Populations
Rural Population
Morbidity
Safety
Costs and Cost Analysis
Mortality
Neoplasms
Surgeons
Therapeutics

Keywords

  • Esophagectomy
  • Regionalization
  • Regionalization of surgeries
  • Surgical outcome-volume relationships

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Regionalization of esophagectomy : Where are we now? / Clark, James M.; Boffa, Daniel J.; Meguid, Robert A.; Brown, Lisa M.; Cooke, David T.

In: Journal of Thoracic Disease, Vol. 11, 01.01.2019, p. S1633-S1642.

Research output: Contribution to journalReview article

Clark, James M. ; Boffa, Daniel J. ; Meguid, Robert A. ; Brown, Lisa M. ; Cooke, David T. / Regionalization of esophagectomy : Where are we now?. In: Journal of Thoracic Disease. 2019 ; Vol. 11. pp. S1633-S1642.
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