Surgeon Specialty Is Associated With Outcome in Rectal Cancer Treatment

Read, Thomas E.; Myerson, Robert J.; Fleshman, James W.; Fry, Robert D.; Birnbaum, Elisa H.; Walz, Bruce J.; Kodner, Ira J.

doi:10.1007/s10350-004-6327-5

Cited by 97 publications

(69 citation statements)

References 62 publications

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“…Dooley et al [8] reported the OS and disease-free survival of breast cancer were significantly improved if the surgery was performed by surgical oncologists rather than general surgeons. Read et al [9] demonstrated that surgeon specialty contributed to prolonged disease-free survival and a higher rate of local control for colorectal cancer, and the background of the surgeon (colorectal or noncolorectal) was an independent predictor of disease-free survival. Barbas et al [10] found the OS of colon cancer patients was significantly improved if the operation was performed by a specialty-trained surgeon, and surgeon specialization was an independent predictor of improved OS.…”

Section: Discussionmentioning

confidence: 99%

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The positive impact of surgeon specialization on survival for gastric cancer patients after surgery with curative intent

Liang

Wang

et al. 2014

Gastric Cancer

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Background Many studies have affirmed the survival benefit for cancer patients treated by specialized surgeons. Methods A total of 967 patients with gastric cancer (GC) who underwent gastrectomy with curative intent in our center were enrolled. Patients were categorized into two groups based on surgeon specialization: the specialized group (SG) and nonspecialized group (NSG). To overcome bias due to the different distribution of covariates for the two groups, a one-to-one match was applied using propensity score analysis. After matching, prognosis and recurrence data were analyzed. Results After one-to-one matching, 261 patients in the SG and 261 patients in the NSG had the same characteristics excluding factors associated with surgery. In multivariate analysis for the whole study series, surgeon specialization was an independent prognostic factor for GC patients after surgery. Patients in the SG demonstrated a significantly higher 5-year overall survival than those in the NSG (50.7 vs. 37.2 %, p = 0.001). With the strata analysis, significant prognostic differences between the two groups were only observed in patients at stage IIIa-b or N1-2. The proportion of locoregional recurrence was greater in the NSG than in the SG. Conclusion GC patients treated by specialized surgeons tended to have a better prognosis and lower locoregional recurrence rate. Surgeon specialization was an independent prognostic factor for GC patients after surgery. GC should be treated by specialized surgeons in large-volume centers.

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Section: Discussionmentioning

confidence: 99%

“…Compared with hospital volume, surgeon specialization can better predict surgical outcome in a given center. Many studies have affirmed the survival benefit for cancer patients treated by specialized surgeons [5][6][7][8][9][10]. With regard to gastric cancer, few studies focus on surgeon specialization.…”

Section: Introductionmentioning

confidence: 99%

The positive impact of surgeon specialization on survival for gastric cancer patients after surgery with curative intent

Liang

Wang

et al. 2014

Gastric Cancer

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“…1 Comparison of local recurrence risk between the learning TME group (G1) and the learned TME group (G2-4), who underwent curative resections, analyzed by the Kaplan-Meier plot (p = 0.035, log rank test) Fig. 2 Comparison of local recurrence risk between the learning TME group (G1) and the learned TME group (G2-4), who underwent curative resections according to TNM stage (a TNM stage II, b TNM stage III), analyzed by the Kaplan-Meier plot (*log rank test) factors for local recurrence of rectal cancer [3][4][5]. Because the surgery must be the science, the surgeon factor should be minimized as much as possible.…”

Section: Discussionmentioning

confidence: 99%

Does Total Mesorectal Excision Require a Learning Curve? Analysis from the Database of a Single Surgeon’s Experience

Kim

Paek

et al. 2011

World j. surg.

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Background The procedure of total mesorectal excision (TME) is the gold standard in the treatment of rectal cancer. However, quality control of TME is still under debate. The present study was conducted to determine whether TME requires a learning curve to allow the surgeon to grasp the necessary technical expertise. Methods We performed a retrospective review of patients with rectal cancer who underwent TME with curative intention between August 1998 and December 2003; 195 consecutive patients were enrolled. From the first patient of the cohort, the first 50 patients were categorized into group 1, the next 50 into group 2, the next 50 into group 3, and the final 45 patients into group 4. Local recurrence rates were compared between the four groups. Results No significant difference in clinicopathological features was observed between the four groups, except for age, operative time, and grade of mesorectum. The local recurrence (LR) rate decreased from 22.3% in the inadequate TME group (G1) to 9.1% in the adequate TME group (G2-4) (p = 0.035). In multivariate analysis, regional lymph node metastasis, mesorectal grade (incomplete or nearly complete), and early period of learning curve were independent predictors of local recurrence. Conclusions Our results suggest that a learning curve is necessary for the development of technical expertise in the performance of TME for treatment of rectal cancer.

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“…O potencial qualitativo do cirurgião para o tratamento do câncer colorretal tem sido avaliado através de dois aspectos inter-relacionados, sendo estes a especificidade de sua formação e a regularidade de sua experiência, usualmente quantificada a partir do número de ressecções colorretais anuais 8,[13][14][15] .…”

Section: Discussionunclassified

“…Read e cols 15 publicaram uma revisão retrospectiva realizada por médicos radioterapêutas, incluindo 384 pacientes submetidos ao tratamento cirúrgico do câncer retal após radioterapia neoadjuvante, com o objetivo de comparar resultados obtidos por cirurgiões colorretais (n=251) e não colorretais (n=133). Os pacientes operados por especialistas apresentaram melhores resultados em relação à sobrevida de cinco anos (77% x 68%, p<0,005) e ao controle local da doença (93% x 84%, p<0,005).…”

Section: Discussionunclassified

Tratamento cirúrgico do câncer colorretal: resultados a longo prazo e análise da qualidade

Pinho

Ferreira

Kleinubing

2006

Rev bras. colo-proctol.

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RESUMO: A obtenção de resultados cada vez melhores no tratamento do câncer colorretal apresenta-se hoje como um desafio devido à sua crescente prevalência em todo o mundo. Diversos estudos têm demonstrado que a qualidade do tratamento cirúrgico instituído representa um dos principais fatores prognósticos, podendo ser esta avaliada através de aspectos como mortalidade operatória, preservação esfincteriana, recorrência local e sobrevida. O objetivo do presente trabalho é apresentar os resultados obtidos a longo prazo no tratamento cirúrgico do câncer colorretal pelo Grupo de Coloproctologia do Departamento de Cirurgia do Hospital Municipal São José, em Joinville, e confrontá-los com a literatura a respeito, visando obter uma avaliação crítica da qualidade do tratamento instituído. Foi realizada uma análise prospectiva de uma série consecutiva de 97 pacientes submetidos ao tratamento cirúrgico do câncer colorretal, com perspectivas curativas e tempo de seguimento médio de 80,8 meses. Foi observada mortalidade operatória em seis pacientes (6,1%), recidiva local para câncer retal e colônico em seis (12,5%) e quatro (9,7%) pacientes, respectivamente, e a necessidade de realização de colostomia definitiva no câncer retal em 14 casos (27%). A sobrevida geral média foi de 48,9 meses. A sobrevida geral de cinco anos para o seguimento oncológico (n=63) foi de 52%, sendo 89% para pacientes estágio 1, 70% para pacientes estágio 2 e 20% para pacientes estágio 3. Concluímos que o tratamento instituído encontra-se dentro dos padrões aceitáveis do ponto de vista da literatura, demonstrando, no entanto, a necessidade de aprimoramento em alguns aspectos específicos. Descritores Trabalho realizado no Departamento de Cirurgia do Hospital Municipal São José, Joinville(SC) e Disciplina de Clínica Cirúrgica, Departamento de Medicina, UNIVILLE, Joinville (SC). Recebido em 14/09/2006 Aceito para publicação em 04/10/2006A obtenção de resultados cada vez melhores no tratamento cirúrgico do câncer colorretal apresenta-se hoje como um desafio permanente, devido à sua crescente prevalência em todo o mundo. Embora tenha ocorrido uma importante redução da morbidade e mortalidade operatórias ao longo das últimas décadas em conseqüência de melhores cuidados pré e pós operatórios, os resultados oncológicos a longo prazo não apresentaram uma variação semelhante, persistindo os níveis de sobrevida bastante próximos àqueles observados no início do século passado. Visando melhorar estes resultados, sucessivas alterações têm sido propostas em diferentes aspectos do tratamento 1 .No que diz respeito à técnica operatória, tentativas de ampliação da radicalidade através de ligaduras vasculares altas ou linfadenectomias pélvicas alargadas mostraram-se controversas quanto à sua efetividade 2 , enquanto a ressecção do mesorreto intacto representou um real avanço no sentido de reduzir a incidência de recidivas locais 3 .Outros importantes benefícios em relação à obtenção de melhores resultados oncológicos tem sido obtidos através do aprimoramento de terapias...

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Surgeon Specialty Is Associated With Outcome in Rectal Cancer Treatment

Abstract: Good outcome for patients with adenocarcinoma of the rectum who undergo neoadjuvant external beam radiotherapy and proctectomy is associated with subspecialty training in colon and rectal surgery.

Cited by 97 publications

References 62 publications

The positive impact of surgeon specialization on survival for gastric cancer patients after surgery with curative intent

The positive impact of surgeon specialization on survival for gastric cancer patients after surgery with curative intent

Does Total Mesorectal Excision Require a Learning Curve? Analysis from the Database of a Single Surgeon’s Experience

Tratamento cirúrgico do câncer colorretal: resultados a longo prazo e análise da qualidade

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