Results of esophagectomy in high-and low-volume centers

The article published by Rouvelas et al1 about the short- and long-term outcomes of esophagectomy for esophageal cancer in high-volume centers vs low-volume centers has been well presented in a highly scientific fashion in a cohort and retrospective study. The authors have proved their hypothesis, at least in Sweden. Furthermore, the authors feel that the outcome of surgery for esophageal carcinoma depends on the biology and stage of the disease. Such a statement is applicable to all malignant neoplasm. But that does not imply that surgeons should compromise the treatment. It is likely that this hypothesis is not true in North America. There are 14 000 new cases of esophageal cancer each year in United States with high mortality and postoperative morbidity even in high-volume centers in the hands of the most experienced surgeons. The old paradigm for the treatment of esophageal cancer, which consisted . . . [Full Text of this Article