Influence of hospital- and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy

Holm, Torbjörn; Johansson, Hemming; Cedermark, Björn; Ekelund, G; Rutqvist, Lars‐Erik

doi:10.1046/j.1365-2168.1997.02745.x

Cited by 131 publications

(135 citation statements)

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“…A number of studies demonstrated better patient outcomes in teaching versus nonteaching hospitals. [13][14][15] Others found lower mortality with increasing hospital or surgeon volume. [16;17] However, studies on mortality among patients with colon cancer showed conflicting results: some demonstrated an association between mortality and hospital volume or teaching status, while others did not.…”

Section: Introductionmentioning

confidence: 99%

Disparities in quality of care for colon cancer between hospitals in the Netherlands

Elferink

Wouters

Krijnen

et al. 2010

European Journal of Surgical Oncology (EJSO)

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Section: Introductionmentioning

confidence: 99%

Disparities in quality of care for colon cancer between hospitals in the Netherlands

Elferink

Wouters

Krijnen

et al. 2010

European Journal of Surgical Oncology (EJSO)

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“…En el cáncer colorrectal, sin embargo, los resultados son contradictorios. De este modo, McArdle y Hole (10), entre otros (7,20), demostraron que los cirujanos con mayor experiencia o especialistas en cirugía colorrectal obtenían mejores resultados en cuanto a supervivencia y en cuanto a recidiva que los no especialistas. Resultados similares obtuvieron Harmon y cols.…”

Section: Discussionunclassified

“…chos autores han estudiado la posible relación entre el grado de especialización en cirugía colorrectal de un cirujano y sus resultados (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). No obstante, estos estudios comparativos (cirujano especialista frente a cirujano no especialista) no siempre han contado con las garantías metodoló-gicas necesarias para extraer conclusiones basadas en la auténtica evidencia científica.…”

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Influencia de la especialización del cirujano en los resultados tras cirugía por cáncer de colon: Utilidad de los índices de propensión (propensity scores)

Martínez-Ramos

Escrig-Sos

Miralles-Tena

et al. 2008

Rev. esp. enferm. dig.

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INTRODUCCIÓNLa influencia del factor cirujano en los resultados quirúrgicos ha sido analizada de manera reiterada y para diferentes tipos de cáncer en la literatura científica mundial (1,2). El cáncer de colon no ha sido una excepción y mu- RESUMENIntroducción: la influencia del factor cirujano en el cáncer colorrectal se ha estudiado de manera reiterada en literatura científi-ca, pero los resultados han sido contradictorios. Se plantea en este estudio si la especialización del cirujano es un factor determinante del pronóstico en estos pacientes. Asimismo, se valora la importancia de los índices de propensión (PS) en el análisis de los resultados.Pacientes y métodos: se planteó un estudio retrospectivo con revisión de las historias clínicas de 236 pacientes sometidos a cirugía por cáncer de colon en el Hospital General de Castellón. Se establecieron dos grupos de cirujanos (especialista y no especialista), comparando los resultados en cuanto a supervivencia y en cuanto a intervalo libre de enfermedad a los 5 años. Inicialmente, se realizaron las comparaciones sin el ajuste de los resultados y, posteriormente, utilizando los PS.Resultados: el primer análisis de los resultados (sin ajuste) fue claramente favorable al grupo de cirujanos especialistas (supervivencia a los 5 años del 64,3 frente al 79,3%, p = 0,028). No obstante, cuando se ajustó mediante los PS, no se obtuvo dicha significación estadística.Conclusiones: no se ha podido demostrar que la especialización del cirujano sea un factor determinante del pronóstico en los pacientes sometidos a cirugía por cáncer de colon. Los índices de propensión pueden ser de gran utilidad para el ajuste de los resultados en estudios retrospectivos no aleatorizados, especialmente cuando el factor de estudio es poco frecuente.Palabras clave: Cáncer de colon. Resultados. Especialización. Índices de propensión. ABSTRACTIntroduction: surgeon influence on colorectal cancer surgery outcomes has been repeatedly studied in the scientific literature, but conclusions have been contradictory. Here we study whether surgeon specialization is a determinant factor for outcome in these patients. The importance of propensity scores (PS) in surgical research is also studied.Patients and methods: a retrospective study was performed and medical records were reviewed for 236 patients who were intervened for colon cancer in Castellon General Hospital (Spain). Cases were divided into two groups (specialist and non-specialist surgeons), and both 5-year surveillance and disease free survival were compared. Comparisons were first made with no adjustments, and then subsequently using PS analysis.Results: the initial (non-adjusted) analysis was clearly favourable for the specialist surgeon group (5-year surveillance, 64.3 vs. 79.3%, p = 0.028). After adjusting for PS no statistical significance was obtained.Conclusions: surgeon specialization had no significant impact on patient outcome after colon cancer surgery. Propensity score analysis is an important tool in the analysis of surgical non-randomiz...

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“…While there is growing evidence that preoperative radiotherapy and TME have an additive (Holm et al, 1997) effect on improvement of local recurrence rates, it is becoming clear that preoperative radiotherapy for 'good' prognosis patients is overtreatment that wastes resources and leads to significant morbidity. Many studies have shown that the depth of extramural invasion, nodal involvement and CRM involvement are independent markers of poor prognosis (Cawthorn et al, 1986;Jass and Love, 1989;Adam et al, 1994;Hall et al, 1998) and selection for neoadjuvant therapy is being increasingly based on these.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging?

et al. 2004

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In rectal cancer, preoperative staging should identify early tumours suitable for treatment by surgery alone and locally advanced tumours that require therapy to induce tumour regression from the potential resection margin. Currently, local staging can be performed by digital rectal examination (DRE), endoluminal ultrasound (EUS) or magnetic resonance imaging (MRI). Each staging method was compared for clinical benefit and cost-effectiveness. The accuracy of high-resolution MRI, DRE and EUS in identifying favourable, unfavourable and locally advanced rectal carcinomas in 98 patients undergoing total mesorectal excision was compared prospectively against the resection specimen pathological as the gold standard. Agreement between each staging modality with pathology assessment of tumour favourability was calculated with the chance-corrected agreement given as the kappa statistic, based on marginal homogenised data. Differences in effectiveness of the staging modalities were compared with differences in costs of the staging modalities to generate cost effectiveness ratios. Agreement between staging and histologic assessment of tumour favourability was 94% for MRI (k ¼ 0.81, s.e. ¼ 0.05; k W ¼ 0.83), compared with very poor agreements of 65% for DRE (k ¼ 0.08, s.e. ¼ 0.068, k W ¼ 0.16) and 69% for EUS (k ¼ 0.17, s.e. ¼ 0.065, k W ¼ 0.17). The resource benefits resulting from the use of MRI rather than DRE was d67164 and d92244 when MRI was used rather than EUS. Magnetic resonance imaging dominated both DRE and EUS on cost and clinical effectiveness by selecting appropriate patients for neoadjuvant therapy and justifies its use for local staging of rectal cancer patients.

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Influence of hospital- and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy

Abstract: There was a significant surgeon-related variation in patient outcome, which is probably related to the surgical technique. Although improved technique may reduce the local recurrence rate, preoperative radiotherapy is still beneficial concerning local control and survival.

Cited by 131 publications

References 24 publications

Disparities in quality of care for colon cancer between hospitals in the Netherlands

Disparities in quality of care for colon cancer between hospitals in the Netherlands

Influencia de la especialización del cirujano en los resultados tras cirugía por cáncer de colon: Utilidad de los índices de propensión (propensity scores)

Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging?

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