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Division of Thoracic Surgery, Ottawa Hospital–General Campus, 501 Smyth Rd, Ottawa ON K1H8L6, Canada
(Email: ssundaresan@ottawahospital.on.ca).
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To the Editor:
We thank Drs Li and de Mol for their insightful letter and comments [1] regarding our recent report on thoracic surgical oncology standards in Ontario [2] and we offer the following reply.
First, Drs Li and de Mol point out that most of the evidence linking a high volume of lung cancer surgery with lower operative mortality are derived from the United States and that the potential for competition between American hospitals may amplify the actual differences in outcomes between them. In our review, we have acknowledged the limitations in the available literature. However, our review assessed the relationship between volume-related and outcome indicators for lung and esophageal resection from
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