为了癌症食管切除术的区域化程度不断增加，患者可能会前往一家机构接受手术，然后在离家更近的地方接受化疗。我们探讨了护理分散、提供化疗的二级机构的癌症委员会认证情况以及执行手术的机构类型对患者生存率的影响。我们查询了全国癌症数据库，以识别在2006年至2019年期间接受食管癌食管切除术和围手术期化疗的所有患者。患者被分为单一中心照护、分散至癌症委员会认证护理或分散至非癌症委员会认证护理。我们使用多变量 logistic 回归、Kaplan-Meier 生存分析和 Cox 比例风险模型来确定相关性。总共有 18,502 位患者符合纳入标准：8,290 位（44.8%）接受单一中心护理，3,414 位（18.5%）接受分散至癌症委员会认证护理，6,798 位（36.4%）接受分散至非癌症委员会认证护理。在白人患者中，分散护理更常见（调整后的奥斯比比率 = 1.25；P < .001），而在非都会地区患者中，分散护理更常见（调整后的奥斯比比率 = 1.36；P < .001）。单一中心护理和分散护理的总体生存率相当，但在学术中心接受食管切除术与生存率提高有关（调整后的风险比 = 0.82；P = .016）。在非学术中心接受食管切除术的患者中，如果围手术期化疗在癌症委员会认证的机构进行，其总体生存率最佳，相较于在分散至非癌症委员会认证中心进行化疗（P = .022）。美国大多数食管癌护理是在多个机构之间分散的。当护理分散时，最常见的是围手术期化疗在非癌症委员会认证中心进行。食管切除术在学术中心进行，并在癌症委员会认证机构进行围手术期治疗时，总体生存率最佳。Elsevier 公司发表。

Increasing regionalization for esophagectomy for cancer may lead patients to travel for surgery at one institution and receive chemotherapy at another closer to home. We explore the effects on survival for care fragmentation, the Commission on Cancer status of secondary institutions providing chemotherapy, and the type of institution performing surgery.We queried the National Cancer Database to identify all patients who underwent esophagectomy for esophageal cancer and received perioperative chemotherapy between 2006 and 2019. Patients were divided into single-center care, fragmented-to-Commission on Cancer care, or fragmented-to-non-Commission on Cancer care. We identified associations using multivariable logistic regression, Kaplan-Meier survival analyses, and Cox proportional hazards models.A total of 18,502 patients met the criteria for inclusion: 8,290 (44.8%) received single-center care; 3,414 (18.5%) fragmented-to-Commission on Cancer care; and 6,798 (36.4%) fragmented-to-non-Commission on Cancer care. Fragmented care was more likely in White patients (adjusted odds ratio = 1.25; P < .001) and in patients nonadjacent to a metropolitan area (adjusted odds ratio = 1.36; P < .001). Overall survival was equivalent between single-center and fragmented care, but undergoing an esophagectomy at an academic center was associated with improved survival (adjusted hazard ratio = 0.82; P = .016). In patients with an esophagectomy at a nonacademic center, overall survival was best if perioperative chemotherapy was administered at Commission on Cancer-accredited facilities compared with chemotherapy at fragmented-to-non-Commission on Cancer centers (P = .022).Most of the esophageal cancer care in the US is fragmented at multiple institutions. When care is fragmented, it is most commonly at non-Commission on Cancer centers for perioperative chemotherapy. Overall survival is best when esophagectomy is performed at an academic center, and perioperative therapy is administered at Commission on Cancer-accredited facilities.Published by Elsevier Inc.