title: The surgeon's expertise-outcome relationship in gastric cancer surgery.
abstract: OBJECTIVE
  The surgical caseload or duration of practice of a surgeon may influence the outcomes of gastric cancer surgery. This study aimed to clarify the surgical quality provided by specialized gastric cancer surgeons.
  
  
  METHODS
  The postoperative courses of 1,877 patients who underwent surgery for gastric cancer were retrospectively reviewed. For classification of the surgeon's expertise, the number of yearly resections performed by, and consecutive years of practice of, the surgeons were used. The outcome measures used were the 30-day mortality and long-term survival.
  
  
  RESULTS
  Surgical mortalities of patients who underwent surgery by a specialized surgeon and those by a general surgeon revealed no statistically significant difference. A significant difference in the five-year survival rates was found with surgeons with at least two consecutive years of practice compared to those with less than two years, when 50 or more cases had been conducted per year (63.9% and 59.7%; p=0.0380). In cases of four-years of consecutive practice, the five-year survival rate was significantly improved, even if only 10 cases were performed annually (64.9% and 58.3%; p=0.0023), although the best survival rate was found with surgeons that had performed 50 or more surgeries per year.
  
  
  CONCLUSIONS
  Improved survival rates, with acceptable surgical mortality, can be achieved for gastric cancer when the surgery is performed by a specialized surgeon. A specialized gastric cancer surgeon can be defined as one who has operated on more than 50 new cases per year, with 2 or more consecutive years of surgical practice.
authors: Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea. wyu@mail.knu.ac.kr
authors: Wansik
authors: W
authors: Yu
authors: Young Kook
authors: YK
authors: Yun
authors: Ilwoo
authors: I
authors: Whang
authors: Gyu Seok
authors: GS
authors: Choi