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Background: Esophagectomy is commonly performed by general or thoracic surgeons and the type of operation is often dictated by the surgeons’ training.
Objective: The objective of the current study was to investigate the volume of operations and outcomes of esophagectomies performed by subspecialty vs. non-subspecialty surgeons.
Data Sources and Study Selection: Clinical data of patients who underwent partial or total esophagectomy for esophageal cancer from 2003 through 2007 were obtained from the University HealthSystem Consortium database. This database contains data from all major teaching hospitals in the US. The data were categorized between general vs. thoracic surgeon and were reviewed for the type and number of operations performed by each surgical specialty, demographics, length of stay, and postoperative morbidity and mortality.
Data Synthesis: During the 60-month period, a total of 2,657 esophagectomies were performed; 1,079 (41%) were performed by general surgeons, while 1,578 (59%) were performed by cardiothoracic surgeons.
Conclusions: The majority of esophagectomies for carcinoma of the esophagus are being performed by subspecialty trained surgeons. Thoracic specialists perform more Ivor-Lewis esophagectomies, while general surgeons favor the blunt transhiatal approach. Despite these differences, specialty training does not appear to be an important factor in determining the outcome for this complex operation.
| General Surgeons | Cardiothoracic surgeons | p value | |
| Total no. of esophagectomies | 1,079 | 1,578 | N/A |
| Procedure, blunt transhiatal (%) | 56 | 37 | <0.01* |
| Procedure, Ivor-Lewis (%) | 44 | 63 | <0.01* |
| Gender: male | 4.3 | 4.2 | N/A |
| Mean ICU stay (days) | 8.4 | 9.7 | 0.287† |
| Mean length of hospital stay (days) | 16.6 | 16.9 | 0.800† |
| Overall complications (%) | 55 | 52 | 0.11* |
| Observed mortality (%) | 3.6 | 2.9 | 0.31* |
| Mortality index (obs/exp) | 0.79 | 0.65 | N/A |
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