The influence of training level and surgical experience on survival in colorectal cancer.
OBJECTIVE
The effect of surgical training level, experience, and operation volume on complications and survival in colorectal cancer during a 10-year period in a medium-volume university hospital was retrospectively studied.


METHODS
Four hundred and fifty-six patients were resected for primary colorectal adenocarcinoma during the 10-year period of 1981-1990, and of these, 387 patients underwent resection with curative intent. The surgeons were divided into three groups according to training level and volume: group 1, surgeons in training and other surgeons operating annually on only 1-4 patients; group 2, surgeons specializing in gastrointestinal surgery (average annual volume 4-13 operations); group 3, specialists in gastrointestinal surgery (average annual volume 3-8 operations). Postoperative morbidity and mortality rates, as well as long-term survival rates, were analysed, and comparisons were made between the patients in the three groups.


RESULTS
There were no statistically significant differences between the three groups in postoperative morbidity or mortality. Cancer-specific 5-year survival rate of all patients was 57%, and that of those resected in the aforementioned three groups was 51%, 63%, and 55%, respectively, P=0.087. The 5-year survival rates for colon cancer were 59% (total), 52%, 69%, and 58%, respectively, P=0.067, and for rectal cancer were 51% (total), 42%, 53%, and 52%, respectively, P=0.585.


CONCLUSIONS
There were no significant differences in the rates of postoperative mortality, morbidity, and long-term overall survival between the volume groups. However, in patients with colon cancer, there was a trend for better survival for those operated on by the surgeons specializing in gastrointestinal surgery, and in rectal cancer patients, a tendency of fewer local recurrences in those operated on by the specialist surgeons.
Hilska
Marja
M
Department of Surgery, Turku University Central Hospital, 20520 Turku, Finland. marja.hilska@pp.inet.fi
Roberts
Peter J
PJ
Kössi
Jyrki
J
Paajanen
Hannu
H
Collan
Yrjö
Y
Laato
Matti
M
D000368:Aged; D002983:Clinical Competence; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005387:Finland; D005762:Gastroenterology; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies