Modifiable risk factors in colorectal surgery: central role of surgeon's volume.
BACKGROUND
Our objective was to inform the ongoing debate regarding selective referral of colorectal cancer patients to high-volume surgeons in order to improve outcomes.


METHODS
We evaluated data on patients treated by colorectal-dedicated surgeons (first study-group) and non specialized surgeons (second study-group). Particular attention has been paid to patients selection in order to collect two study-groups with similar demographic and clinical characteristics, differing only as regards providers' surgical experience in the colorectal field. We focused on postoperative mortality and 5-year overall and cancer-specific survival. We also analyzed resection rates of the primary tumor and colostomy rates for patients with stage I to III rectal cancer, and use of (neo)adjuvant (chemo)radiation therapy for patients with stage II-III rectal cancer by surgeon's volume.


RESULTS
The analysis of these 2 study-groups shows better results for patients treated by colorectal-trained surgeons (high-volume surgeons) for each parameter taken into account: lower postoperative mortality (OR 0.32; 95% CI:0.7-0.1; p = 0.04), increased 5-year overall and cancer specific survival (rising from 41.2% and 46.4% to 56% and 61.2% respectively; OR 1.8; 95% CI: 1.3-2.6; p < 0.005). Patient treated by non specialized surgeons are more likely to receive a permanent colostomy (abdominoperineal resection: APR) (OR 5.9; 95% CI: 3.3-10.7) and to undergo a non-resective procedure (OR 4.8; 95% CI: 1.9-12)(p < 0.005). No difference was found between the 2 study-groups in the use of (neo)adjuvant (chemo)radiation therapy for patients with stage II-III rectal cancer.


CONCLUSIONS
Our analysis suggests that surgeon's volume does impact on outcomes for patients undergoing surgery due to colorectal cancer.
Cattedra di Chirurgia Generale, University of Brescia School of Medicine, Brescia, Italy. giacomopata@alice.it
Giacomo
G
Pata
Claudio
C
Casella
Riccardo
R
Nascimbeni
Laura
L
Cirillo
Bruno
B
Salerni
D000368:Aged; D002983:Clinical Competence; D015179:Colorectal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003107:Colorectal Surgery / Q000193:education* / Q000706:statistics & numerical data*; D003125:Colostomy / Q000379:methods; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010820:Physicians / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data*