Esophagectomy performed at institutes certified by the Japan Esophageal Society provide long-term survival advantages to esophageal cancer patients: second report analyzing 4897 cases with propensity score matching

Abstract

Background It will be important for the Japan Esophageal Society (JES) to show an evident advantage of its institution certification system. To achieve this essential task, we used nationally acquired big data to re-analyze 5-year survival information. Methods In 2008-2009, there were 4897 thoracic esophageal cancer patients who underwent esophagectomy and were registered in the National Database of Hospital-based Cancer Registries. We divided these patients into two groups, those who underwent surgery at an Authorized Institute for Board Certified Esophageal Surgeons (AIBCES) or a Non-AIBCES. We then compared the patient backgrounds and 5-year survival rates between these two groups, with and without propensity score matching. Results There were 3080 (63%) patients who underwent esophagectomy at an AIBCES and 1817 (37%) who underwent surgery at a Non-AIBCES. Comparison of the Kaplan-Meier survival curves using log-rank tests indicated a significant difference between the AIBCES and Non-AIBCES groups at all cStages (cStages I-IV). Multivariable Cox proportional hazard analysis stratified by clinical stage and adjuvant treatment revealed that AIBCES vs. Non-AIBCES is a significant independent factor (adjusted HR 0.78) for survival. After propensity score matching ensuring the backgrounds of the two groups being equivalent, there were significant differences in the 5-year survival rates for patients with cStages I-III disease between the AIBCES and Non-AIBCES groups. Conclusions There is a survival advantage to undergoing esophagectomy at an AIBCES. The institute certification system from the JES will contribute to the future establishment of a more appropriate surgery delivery system for thoracic esophageal cancer.

Differences in treatment and survival between elderly patients with thoracic esophageal cancer in metropolitan areas and other areas

“…[15][16][17] Moreover, a certification system for surgeons and institutes has improved the surgery-related mortality rate and has demonstrated that there is a significantly better 5-year survival rate among cStage II-III thoracic esophageal cancer patients treated with esophagectomy by a board-certified esophageal surgeon at an authorized institute. [12][13][14] An attached regional disparity in medical care was that adjuvant therapy before and/or after esophagectomy for advanced thoracic esophageal cancer was more frequent in metropolitan areas. To find the causes will require additional research, and our present data do not provide an answer.…”

“…The institute certification system for esophageal surgery by the Japan Esophageal Society has contributed to this moderate centralization. 12 , 13 , 14 Performance of large numbers of esophagectomies (high‐volume hospital) has been shown to correlate with better short‐term surgical results (mortality or postoperative complication). 15 , 16 , 17 Moreover, a certification system for surgeons and institutes has improved the surgery‐related mortality rate and has demonstrated that there is a significantly better 5‐year survival rate among cStage II‐III thoracic esophageal cancer patients treated with esophagectomy by a board‐certified esophageal surgeon at an authorized institute.…”

“… 15 , 16 , 17 Moreover, a certification system for surgeons and institutes has improved the surgery‐related mortality rate and has demonstrated that there is a significantly better 5‐year survival rate among cStage II‐III thoracic esophageal cancer patients treated with esophagectomy by a board‐certified esophageal surgeon at an authorized institute. 12 , 13 , 14 …”

“…The reason is that esophagectomy requires considerable technical skill, and the surgical stress on the patients is extremely high. The institute certification system for esophageal surgery by the Japan Esophageal Society has contributed to this moderate centralization 12‐14 . Performance of large numbers of esophagectomies (high‐volume hospital) has been shown to correlate with better short‐term surgical results (mortality or postoperative complication) 15‐17 .…”