Trends in the management of esophageal carcinoma based on provider volume: treatment practices of 618 esophageal surgeons.
Trends in the management of esophageal carcinoma based on provider volume: treatment practices of 618 esophageal surgeons.
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基于提供者数量的食管癌治疗趋势：618 名食管外科医生的治疗实践。
DOI：
10.1111/j.1442-2050.2009.00985.x
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Jobe,BA
中科院分区：
文献类型：
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作者：
Enestvedt,CK;Perry,KA;Kim,C;McConnell,PW;Diggs,BS;Vernon,A;O'Rourke,RW;Luketich,JD;Hunter,JG;Jobe,BA
关于食道癌的最佳治疗方法存在争议。尽管相对缺乏确定最佳实践的对照试验，但食道切除术已成为医院和手术质量的指标之一。创建了一项调查，以确定不同外科医生在食道癌治疗中的异质性程度，并使用高容量(HV)(≥15例/年)和低容量(LV)(<；15例/年)的名称从外科医生的角度区分食道癌治疗的具体差异。根据社会名册，通过邮件联系了美国和15个国家的外科医生(n= 4000)，并使用一种包含50个项目的调查工具询问他们对食道癌的治疗实践，调查工具涉及人口统计学、新辅助放化疗的使用以及食道切除和姑息手术方法的选择。共有618名食道外科医生参与调查(n= ，1447人)，其中77人(12.5%)被认为是HV。大多数高血压病外科医生(87%)在学术环境中执业并接受过心胸培训，而大多数高血压病医生(52.3%)是私人执业的普通外科医生。HV和LV外科医生均倾向于手工缝合颈部吻合和胃导管。与LV外科医生相比，HV外科医生进行微创食道切除术的频率更高(P= 0.045)。大多数HV外科医生对有结节受累的患者使用新辅助治疗，而LV外科医生更有可能将决定留给肿瘤学家。除了少数值得注意的例外，外科医生对食道癌的管理策略存在显著的异质性，特别是当按病例数量分组和分析时。这些结果强调了需要进行对照试验，以确定治疗这一复杂患者群体的最佳做法。
Controversy exists regarding optimal treatment practices for esophageal cancer. Esophagectomy has received focus as one of the index procedures for both hospital and surgical quality despite a relative paucity of controlled trials to define best practices. A survey was created to determine the degree of heterogeneity in the treatment of esophageal cancer among a diverse group of surgeons and to use high-volume (HV) (≥15 cases/year) and low-volume (LV) (<15 cases/year) designations to discern specific differences in the management of esophageal cancer from the surgeon's perspective. Based on society rosters, surgeons (n= 4000) in the USA and 15 countries were contacted via mail and queried regarding their treatment practices for esophageal cancer using a 50-item survey instrument addressing demographics, utilization of neoadjuvant chemoradiotherapy, and choice of surgical approach for esophageal resection and palliation. There were 618 esophageal surgeons among respondents (n= 1447), of which 77 (12.5%) were considered HV. The majority of HV surgeons (87%) practiced in an academic setting and had cardiothoracic training, while most LV surgeons were general surgeons in private practice (52.3%). Both HV and LV surgeons favored the hand-sewn cervical anastomosis and the stomach conduit. Minimally invasive esophagectomy is performed more frequently by HV surgeons when compared with LV surgeons (P= 0.045). Most HV surgeons use neoadjuvant therapy for patients with nodal involvement, while LV surgeons are more likely to leave the decision to the oncologist. With a few notable exceptions, substantial heterogeneity exists among surgeons' management strategies for esophageal cancer, particularly when grouped and analyzed by case volume. These results highlight the need for controlled trials to determine best practices in the treatment of this complex patient population.