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Lugaresi M, Nafteux P, Nilsson M, Reynolds JV, Rosati R, Schoppmann SF, Targarona EM, Mattioli S. Exploring the concept of centralization of surgery for benign esophageal diseases: a Delphi based consensus from the European Society for Diseases of the Esophagus. Dis Esophagus 2021; 34:6148804. [PMID: 33621318 DOI: 10.1093/dote/doab013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Abstract
Surgery for benign esophageal diseases may be complex, requiring specialist training, but currently, unlike oncologic surgery, it is not centralized. The aim of the study was to explore the opinion of European surgeons on the centralization of surgery for benign esophageal diseases. A web-based questionnaire, developed through a modified Delphi process, was administered to general and thoracic surgeons of 33 European surgical societies. There were 791 complete responses (98.5%), in 59.2% of respondents, the age ranged between 41 and 60 years, 60.3% of respondents worked in tertiary centers. In 2017, the number of major surgical procedures performed for any esophageal disease by respondents was <10 for 56.5% and >100 for 4.5%; in responder's hospitals procedures number was <10 in 27% and >100 in 15%. Centralization of surgery for benign esophageal diseases was advocated by 83.4%, in centers located according to geographic/population criteria (69.3%), in tertiary hospitals (74.5%), with availability of advanced diagnostic and interventional technologies (88.4%), in at least 10 beds units (70.5%). For national and international centers accreditation/certification, criteria approved included in-hospital mortality and morbidity (95%), quality of life oriented follow-up after surgery (88.9%), quality audits (82.6%), academic research (58.2%), and collaboration with national and international centers (76.6%); indications on surgical procedures volumes were variable. The present study strongly supports the centralization of surgery for benign esophageal diseases, in large part modeled on the principles that have underpinned the centralization of cancer surgery internationally, with emphasis on structure, process, volumes, quality audit, and clinical research.
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Affiliation(s)
- Marialuisa Lugaresi
- Department of Medical and Surgical Sciences (DIMEC) and Division of Thoracic Surgery, Alma Mater Studiorum, University of Bologna Maria Cecilia Hospital Cotignola (RA), Bologna, Italy
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Magnus Nilsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - John V Reynolds
- National Esophageal and Gastric Cancer Center, St James's Hospital and Trinity College, Dublin, Ireland
| | - Riccardo Rosati
- Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita Salute University, Milan, Italy
| | - Sebastian F Schoppmann
- Comprehensive Cancer Center Vienna, Upper GI Tumors Unit, Medical University of Vienna, Wien, Austria.,Department of Surgery, Medical University of Vienna, Wien, Austria
| | - Eduardo M Targarona
- Department of General and Digestive Surgery, Hospital De La Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Sandro Mattioli
- Department of Medical and Surgical Sciences (DIMEC) and Division of Thoracic Surgery, Alma Mater Studiorum, University of Bologna Maria Cecilia Hospital Cotignola (RA), Bologna, Italy
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de la Plaza Llamas R, García Gil JM, Ramia Ángel JM. Standardizing the treatment of esophagogastric junction tumors: Centralization, registries and surgical training. Cir Esp 2019; 97:609-611. [PMID: 31362837 DOI: 10.1016/j.ciresp.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Roberto de la Plaza Llamas
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - José Manuel García Gil
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - José Manuel Ramia Ángel
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
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