The state of centralization of esophageal cancer surgery in France and Europe in 2023?

Esophagectomy for cancer is a complex surgical procedure, the mainstay of a multimodal treatment strategy. Postoperative mortality remains high, estimated at between 0.9% and 25%. To improve postoperative outcomes, some countries, such as the Netherlands and England, have established national audit programmes. Differences in the quality of care between countries have been observed, possibly related to different organisational structures. In addition to national audits, other organisational characteristics, such as centralisation of care, influence postoperative outcomes. Studies have shown a positive association between centre volume and cancer oesophagectomy outcomes, with lower mortality and better survival in high-volume centres. In some countries, these studies have led to a first wave of centralisation. In France, studies based on the PMSI have shown a 70% reduction in the risk of postoperative mortality in very high-volume centres (60 esophagectomy/year). As a result, minimum activity thresholds have been defined in the Official Journal of April 2022 and should be applied soon, as well as technical platform requirements. At the European level, a study carried out in 16 countries revealed differences in the centralisation of esophageal surgery, the organisation of national audits and the training of young surgeons. Many countries are considering further centralisation of esophageal cancer surgery, but this is an organisational and structural challenge. Modern surgical quality criteria (textbook outcome, failure-to-rescue) and consideration of volume per surgeon rather than per centre are also discussed.

1 Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, CHU Lille, F-59000 Lille, Lille, France
2 Department of Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
3 Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands