• JawitzNicole GNGDivision of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina., Vignesh Raman, Oliver K Jawitz, Rahul A Shimpi, Richard K Wood, Matthew G Hartwig, and Thomas A D'Amico.
• Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
• Ann. Surg. 2023 Jan 1; 277 (1): e46e52e46-e52.

ObjectivesWe describe utilization trends and center volume-outcomes relationship of ER of early stage esophageal cancer using a large hospitalbased registry.Summary Of Background DataER is increasingly accepted as the preferred treatment for early stage esophageal cancer, however its utilization and the center volume-outcomes relationship in the United States is unknown.MethodsThe National Cancer Database was used to identify patients with cT1N0M0 esophageal cancer treated with ER or esophagectomy between 2004 and 2015. Relative frequencies were plotted over time. Restricted cubic splines and maximally selected rank statistics were used to identify an inflection point of center volume and survival.ResultsA total of 1136 patients underwent ER and 2829 patients underwent esophagectomy during the study period. Overall utilization of ER, and relative use compared to esophagectomy, increased throughout the study period. Median annualized center ER volume was 1.9 cases per year (interquartile range 0.5-5.8). Multivariable Cox regression showed increasing annualized center volume by 1 case per year was associated with improved survival. Postoperative 30- or 90-day mortality, 30-day readmission, and pathologic T upstaging rates were similar irrespective of center volume.ConclusionsUtilization of ER compared to esophagectomy for stage I esophageal cancer has increased over the past decade, though many individual centers perform fewer than 1 case annually. increasing annualized center volume by one procedure per year was associated with improved survival. increased volume beyond this was not associated with survival benefit. Referral to higher volume centers for treatment of superficial esophageal cancer should be considered.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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