Evidence map›Paper›PMID 40685458›Full record

SynthesisAnnals of surgical oncology2025

Impact of Centralizing Esophageal Cancer Surgery at High-Volume Centers on Long-Term Survival: Individual Patient Data Meta-Analysis.

Alberto Aiolfi, Davide Bona, Sara De Bernardi, Gianluca Bonitta, Quan Wang, Antonio Biondi, Luigi Bonavina

Abstract readMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Alberto AiolfiI.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy. alberto.aiolfi86@gmail.com.ORCID http://orcid.org/0000-0002-7764-6075
Davide BonaI.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy.
Sara De BernardiI.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy.
Gianluca BonittaI.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy.
Quan WangDepartment of Biomedical Sciences for Health, Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.
Antonio BiondiSurgical Division, Department of General Surgery and Medical Surgical Specialties, G. Rodolico Hospital, University of Catania, 95131, Catania, Italy.
Luigi BonavinaDepartment of Biomedical Sciences for Health, Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCentralization of esophageal cancer surgery in high-volume centers has been shown to be associated with reduced mortality, length of stay, and improved surgical radicality. However, the effect of hospital volume on long-term survival is unclear. The purpose of this study was to evaluate the long-term survival effects of centralizing esophageal cancer surgery in high-volume centers.

methodsPubMed, MEDLINE, Scopus, and Web of Science databases were searched through March 15, 2025. Primary outcome was overall survival (OS). High-volume center was defined in case of ≥7 esophagectomy/surgeon/year or ≥10 esophagectomy/center/year or ≥20 esophagectomy/center/year. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. PROSPERO CRD420251026250.

resultsOverall, 23,194 patients (9 studies) undergoing esophagectomy for cancer were included. Surgery in high-volume centers was performed 62.4%. Patients' ages ranged from 27 to 79 years, and 86% were males. At 5-year follow-up, the multivariate meta-analysis with RMSTD estimation showed that patients operated in high-volume centers survive 4.3 months more on average compared with patients operated in low-volume centers (95% CI 2.7-5.9; p < 0.001). Compared with surgery in low-volume centers, surgery in high-volume centers was associated with a significantly reduced hazard for mortality up to 60 months (HR 0.65, 95% CI 0.53-0.81). The subgroup analysis based on volume group category (≥10 esophagectomy/center/year and ≥20 esophagectomy/center/year) showed consistent results with the overall analysis suggesting significantly improved 5-year OS for high-volume centers.

conclusionsEsophagectomy for cancer conducted in high-volume centers seems associated to improved long-term overall survival and reduced mortality hazard within a 5-year follow-up period.

Indexed as

Esophageal NeoplasmsEsophagectomyHospitals, High-VolumeAdultAgedFemaleHumansMaleMiddle AgedPrognosisSurvival RateEsophageal cancerEsophagectomyHigh-volume centersLow-volume centersOverall survival

Identifiers

PMID40685458

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.