Surgical specialization and training - its relation to clinical outcome for colorectal cancer surgery.
OBJECTIVE
Surgical sub-specialization has been considered to be a major factor in improving cancer surgery-related outcomes in terms of 5-year survival and disease-free intervals. In this article we have looked at the evidence supporting the improvement in colorectal cancer outcomes with 'colorectal specialists' performing colon and rectal surgery.


METHODS
A literature review was carried out using search engines such as Pubmed, Ovid and Cochrane Databases. Only studies looking at colorectal cancer outcome related to surgery were included in our review.


RESULTS
Specialist surgeons performing a high volume of colorectal cancer surgery demonstrated better 5-year survival rates in patients, with less local recurrence. This was most evident in surgery for rectal cancer, where an association with increased sphincter saving surgery was also seen. Total mesorectal excision is now the accepted treatment for rectal cancer and has markedly improved survival rates and decreased local recurrence.


CONCLUSIONS
The outcomes in colorectal surgery continue to steadily improve. The training of specialized colorectal surgeons is a major contributing factor towards this improvement.
Anwar
Suhail
S
Department of General Surgery, Huddersfield Royal Infirmary, Huddersfield, UK. suanwar@btinternet.com
Fraser
Sheila
S
Hill
Jim
J
D015179:Colorectal Neoplasms / Q000601:surgery*; D013502:General Surgery / Q000193:education*; D006801:Humans; D017063:Outcome Assessment, Health Care; D013038:Specialization; D016019:Survival Analysis