The changing role of the surgeon in the management of cancer in the university setting and its impact on resident training.
A retrospective review was performed of 22,168 cancer cases registered by the Tumor Registry between 1965 and 1990. Eighty-six percent of these cases involved solid tumors; this number remained fairly constant throughout the study period. There was a significant trend toward more advanced disease at the time of presentation, most marked in the last 10 years; prior to 1980, 63.7% had localized or in situ cancer as opposed to only 49.4% since 1980 (P < 0.001). This suggested that more advanced cases were being submitted for treatment. As expected, more disseminated disease at the time of presentation was coupled with an overall decrease in the number of cases in which surgery comprised part of the treatment: 43.6% prior to 1980 vs. 38.1% after 1980. This trend has reversed, however, in the last 5 years. Though the number of cases in which surgery was the only treatment modality remained constant prior to and after 1985 (26.8% and 27.1%, respectively), the number of cases in which surgery was part of a multimodality treatment plan significantly increased (39.9% prior to 1985; 45.3% after 1985). This was coupled with a significant decrease in the number of cases treated with nonsurgical modalities alone (60.1% prior to 1985; 54.7% after 1985). Therefore, not only has the surgeon been called upon to operate on more advanced disease for cure in the last 5 years, but he or she has also become increasingly involved in multimodality treatment. Since 40.4% of university departments of surgery (as of 1990) did not provide specific training in surgical oncology, it is suggested that these departments reevaluate the objectives of their educational programs in view of the changing, increasingly complex role of the surgeon in the multidisciplinary approach to the care of the cancer patient.
Sariego
J
J
Department of Surgery, Hahnemann University, Philadelphia, PA 19102.
Byrd
M
M
Matsumoto
T
T
Kerstein
M
M
D003479:Curriculum; D013502:General Surgery / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies