[Influence of the surgeon as a factor in the surgical treatment of rectal cancer with preoperative radiochemotherapy. A comparative study].
BACKGROUND
In the last few years, changes have been introduced in rectal cancer surgery that have improved its results. These changes include autosuture devices, total mesorectal excision, and neoadjuvant treatment. The aim of the present study was to determine whether the surgeon influences the results of surgical treatment for rectal cancer.


METHODS
A comparative, retrospective study was performed in 194 consecutive patients with rectal cancer who underwent preoperative radiotherapy. The patients were divided into two groups according to the type of surgeon performing the intervention: group I: 3 surgeons with 101 patients; group II: 16 surgeons with 93 patients.


RESULTS
Sphincter-preserving surgery was performed in 77% of patients in group I and in 52% of those in group II (p < 0.001). In group I anterior resection was performed in 100%, 100% and 58% when the tumor was between 11-15 cm, 6-10 cm and 1-5 cm, respectively, compared with 100%, 69% and 23.5% in group II. Complications occurred in 41% of patients in group I and in 48% of those in group II (p = 0.037). Length of hospital stay was 9.9 days in group I and 13.9 days in group II (p < 0.001). Local recurrence occurred in 3.5% of patients in group I and in 11.3% of those in group II (p = 0.054). Survival was similar in both groups.


CONCLUSIONS
The surgeon is a key factor in rectal cancer, despite the introduction of autosuture devices, neoadjuvant treatment, and total mesorectal excision. These patients should be operated on by experts in this type of surgery and not by surgeons who perform these interventions only occasionally.
Luján
Juan
J
Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain. juanlujan@telefonica.net
Hernández
Quiteria
Q
Valero
Graciela
G
de las Heras
Manuel
M
Gil
José
J
Frutos
Dolores
D
Parrilla
Pascual
P
D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000592:standards*; D005260:Female; D013502:General Surgery / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies