, Volume 15, Issue 2, pp 115–121 | Cite as

Surgical team proficiency in minimally invasive esophagectomy is related to case volume and improves patient outcomes

  • Akihiko Okamura
  • Masayuki Watanabe
  • Ian Fukudome
  • Kotaro Yamashita
  • Masami Yuda
  • Masaru Hayami
  • Yu Imamura
  • Shinji Mine
Original Article



Minimally invasive esophagectomy (MIE) is being increasingly performed; however, it is still associated with high morbidity and mortality. The correlation between surgical team proficiency and patient load lacks clarity. This study evaluates surgical outcomes during the first 3-year period after establishment of a new surgical team.


A new surgical team was established in September 2013 by two expert surgeons having experience of performing more than 100 MIEs. We assessed 237 consecutive patients who underwent MIE for esophageal cancer and evaluated the impact of surgical team proficiency on postoperative outcomes, as well as the team learning curve.


In the cumulative sum analysis, a point of downward inflection for operative time and blood loss was observed in case 175. After 175 cases, both operative time and blood loss significantly decreased (P < 0.001 and P < 0.001, respectively), and postoperative incidence of pneumonia significantly decreased from 18.9 to 6.5% (P = 0.024). Median postoperative hospital stay also decreased from 20 to 18 days (P = 0.022). Additionally, serum CRP levels on postoperative day 1 showed a significant, but weak inverse association with the number of cases (P = 0.024).


After 175 cases, both operative time and blood loss significantly decreased. In addition, the incidence of pneumonia decreased significantly. Additionally, surgical team proficiency may decrease serum CRP levels immediately after MIE. Surgical team proficiency based on team experience had beneficial effects on patients undergoing MIE.


Minimally invasive esophagectomy Learning curve Volume-outcome Teamwork 


Compliance with ethical standards

Ethical Statement

All procedures were performed in accordance with the ethical standards of our institutional review board and with the Helsinki Declaration of 1964 and later versions. All authors followed the policy concerning Informed Consent.

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© The Japan Esophageal Society and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Akihiko Okamura
    • 1
  • Masayuki Watanabe
    • 1
  • Ian Fukudome
    • 1
  • Kotaro Yamashita
    • 1
  • Masami Yuda
    • 1
  • Masaru Hayami
    • 1
  • Yu Imamura
    • 1
  • Shinji Mine
    • 1
  1. 1.Department of Gastroenterological Surgery, Gastroenterology CenterThe Cancer Institute, Hospital of Japanese Foundation for Cancer ResearchTokyoJapan

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