title: Dose surgical sub-specialization influence survival in patients with colorectal cancer?
abstract: OBJECTIVE
  To perform a review of patients with colorectal cancer to a community hospital and to compare the risk-adjusted survival between patients managed in general surgical units versus a colorectal unit.
  
  
  METHODS
  The study evaluated all patients with colorectal cancer referred to either general surgical units or a colorectal unit from 1/1996 to 6/2001. These results were compared to a historical control group treated within general surgical units at the same hospital from 1/1989 to 12/1994. A Kaplan-Meier survival analysis compared the overall survivals (all-cause mortality) between the groups. A Cox proportional hazards model was used to determine the influence of a number of independent variables on survival. These variables included age, ASA score, disease stage, emergency surgery, adjuvant chemotherapy and/or radiotherapy, disease location, and surgical unit.
  
  
  RESULTS
  There were 974 patients involved in this study. There were no significant differences in the demographic details for the three groups. Patients in the colorectal group were more likely to have rectal cancer and Stage I cancers, and less likely to have Stage II cancers. Patients treated in the colorectal group had a significantly higher overall 5-year survival when compared with the general surgical group and the historical control group (56 % versus 45 % and 40 % respectively, P<0.01). Survival regression analysis identified age, ASA score, disease stage, adjuvant chemotherapy, and treatment in a colorectal unit (Hazards ratio: 0.67; 95 % CI: 0.53 to 0.84, P =0.0005), as significant independent predictors of survival.
  
  
  CONCLUSIONS
  The results suggest that there may be a survival advantage for patients with colon and rectal cancers being treated within a specialist colorectal surgical unit.
authors.affiliation: Department of Surgery, University of Western Australia, Fremantle Hospital, Australia. cplatell@cyllene.uwa.edu.au
authors.forename: Cameron
authors.initials: C
authors.lastname: Platell
authors.forename: Daniel
authors.initials: D
authors.lastname: Lim
authors.forename: Nazreen
authors.initials: N
authors.lastname: Tajudeen
authors.forename: Ji-Li
authors.initials: JL
authors.lastname: Tan
authors.forename: Karen
authors.initials: K
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery; D005260:Female; D013502:General Surgery; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome; D014904:Western Australia