Centralization and Quality Control in Esophageal Cancer Surgery: a Way Forward in Europe.

Esophageal cancer surgery is a complex procedure that can have significant morbidity and mortality. While there have been advancements in minimally invasive techniques and early rehabilitation protocols, these improvements are not consistently implemented across all European countries. Two potential strategies for improving the quality of esophageal cancer surgery are centralization of care and quality control through national clinical audits. Centralization can be achieved through dedicated centers or volume thresholds, and studies have shown that higher volume centers have better outcomes. Implementing these strategies requires overcoming organizational and structural obstacles, but they have the potential to improve the outcome of esophageal cancer surgery in Europe. Quality control can be achieved through mandatory national clinical audits, which provide a framework for monitoring and improving care quality. Multiple countries have reported positive effects from their audits. Comprehensive registration of care quality, including procedural aspects, outcomes, and complications, is essential for effective auditing. The authors recommend implementing minimum annual volume thresholds for esophageal cancer surgery in all European countries, along with clinical care standards and mandatory audits to ensure quality improvement. [Extracted from the article]