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Volume‐ or outcome‐based referral to improve quality of care for esophageal cancer surgery in The Netherlands

Recently, in The Netherlands esophageal resections for cancer are banned from hospitals with an annual volume less than 10. In this study we evaluate the validity of this specific volume cut‐off, based on a review of the literature and an analysis of the available data on esophagectomies in our country. In addition, we compare the expected benefits of volume‐based referral to the results of a regional centralization process based on differences in outcome (outcome‐based referral). J. Surg. Oncol. 2009;99:481–487. © 2009 Wiley‐Liss, Inc.