No influence of surgical volume on patients' health-related quality of life after esophageal cancer resection

Background: Studies on factors that can counteract the negative impact of esophagectomy on patients' health-related quality of life (HRQL) have been sparse. This study was undertaken to examine the question whether hospital or surgeon volume influences HRQL as evaluated 6 months after such surgery. Materials and Methods: A Swedish prospective, population-based cohort study of esophageal cancer patients treated surgically in 2001-2005 was conducted. All patients completed validated HRQL questionnaires, developed by EORTC, addressing general HRQL (QLQ-C30) and esophageal-specific symptoms (QLQ-OES18), 6 months postoperatively. Mean scores with 95% confidence intervals were calculated. Clinically relevant mean score differences (>= 10) between groups were further analyzed in a linear regression model, adjusted for several potential confounders. Results: Some 355 patients were included (80% of eligible). No clinically relevant differences were found between low-volume (0-9 operations/year) and high-volume hospitals (> 9 operations/year) or between low-volume (0-6 operations/year) and high-volume surgeons (> 6 operations/year). Stratified analyses for tumor location did not reveal any differences between hospital or surgeon volume groups. Moreover, no material differences were found between the four individual high-volume hospitals. Conclusion: This study revealed no HRQL advantages of being treated at high-volume hospitals or by high-volume surgeons, as measured 6 months after esophageal cancer resection.