在这项研究中，我们分析了爱尔兰国家中心集中化对关键指标、结果和护理模式的影响。在过去 25 年中，西方食管癌的总体生存率翻了一番。集中化的国际趋势可能是相关的，但这种模式在爱尔兰仍存在争议，爱尔兰于 2011 年集中开展了食管癌手术。所有食管或食管交界处腺癌患者（n = 1245）接受了涉及手术（包括内窥镜手术）的治愈性治疗，包括（2000-2011 年 n= 461，2012-2022 年 n= 784）。所有数据输入均被前瞻性记录。测量了 (i) 整个队列的总体生存率； (ii) 患有局部晚期疾病的患者（cT2-3N0-3）； (iii) 接受新辅助治疗的患者。所有并发症均按照食管并发症共识组 (ECCG) 定义和 Clavien Dindo (CD) 严重程度分类进行记录。使用适用于 Windows 的 GraphPad Prism (v.6.0) 和 SPSS (v.23.0) 软件（SPSS，芝加哥）对数据进行分析，IL）RStudio（Rversion4.2.2）。使用对数秩检验和 Cox 回归分析计算生存时间，并生成 Kaplan-Meier 曲线。在预集中期间，cT1a/IMC 腺癌的内治疗从 40 次（总计 9%）增加到 245 次（总计 31%） （前 C）和后集中化（后 C）时期。在 C 期后患有 cT2-3N0-3 疾病的患者接受新辅助治疗的比例显着较高（P<0.001）（66% vs 53%）。 C 后手术死亡率较低 (P=0.02)，分别为 2% 和 4.5%，且>IIIa CD 主要并发症从 33% 降至 25% (P<0.01)。 C 术后复发率较低（38% vs 53%，P<0.01）。 2012-22 和 2000-11 队列的中位总生存期分别为 73.83 个月和 47.23 个月（P<0.001）。对于接受新辅助治疗的患者，C 前的中位生存期为 28.5 个月，C 后为 42.5 个月（P<0.001）。这些数据强调了自集中治疗以来手术结果和生存率的改善，以及内镜治疗的大幅扩展。外科手术。尽管没有提供证据，但该研究表明，正式集中化管理对关键质量指标以及护理模式的演变产生了积极影响。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

In this study we analyzed the impact of centralization on key metrics, outcomes and patterns of care at the Irish National Center.Overall survival rates in esophageal cancer in the West have doubled in the last 25 years. An international trend towards centralization may be relevant, however this model remains controversial with Ireland, centralizing esophageal cancer surgery in 2011.All patients (n=1245) with adenocarcinoma of the esophagus or junction treated with curative intent involving surgery, including endoscopic surgery, were included (n= 461 from 2000-2011, and 784 from 2012-2022). All data entry was prospectively recorded. Overall survival was measured (i) for the entire cohort; (ii) patients with locally advanced disease (cT2-3N0-3); and (iii) patients undergoing neoadjuvant therapy. All complications were recorded as per Esophageal Complication Consensus Group (ECCG) definitions, and the Clavien Dindo (CD) severity classification.Data were analyzed using GraphPad Prism (v.6.0) for Windows and SPSS (v.23.0) software (SPSS,Chicago,IL) RStudio (Rversion4.2.2). Survival times were calculated using log-rank test and a Cox-regression analysis, and Kaplan-Meier curves generated.Endotherapy for cT1a/IMC adenocarcinoma increased from 40 (9% total) to 245 (31% total) procedures between the pre-centralization (pre-C) and post-centralization (post-C) periods. A significantly (P<0.001) higher proportion of patients with cT2-3N0-3 disease in the post-C period underwent neoadjuvant therapy (66% vs 53%). Operative mortality was lower (P=0.02) post-C, at 2% vs 4.5%, and>IIIa CD major complications decreased from 33% to 25% (P<0.01). Recurrence rates were lower post-C (38% vs 53%, P<0.01). Median overall survival was 73.83 versus 47.23 months in the 2012-22 and 2000-11 cohorts respectively (P<0.001). For those who received neoadjuvant therapy, the median survival was 28.5 months pre-C and 42.5 months post-C (P<0.001).These data highlight improvements in both operative outcomes and survival from the time of centralization, and a major expansion of endoscopic surgery. Although not providing proof, the study suggests a positive impact of formal centralization with governance on key quality metrics, and an evolution in patterns of care.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.