Surgeon and hospital-related risk factors in colorectal cancer surgery.
OBJECTIVE
The aim of this study was to identify surgeon and hospital-related factors in a well-defined population-based cohort; the results of this study could possibly be used to improve outcome in colorectal cancer.


METHODS
Data from the colonic (1997-2006) and rectal (1995-2006) cancer registers of the Uppsala/Örebro Regional Oncology Centre were used to assess 1697 patients with rectal and 2692 with colonic cancer. Putative risk factors and their impact on long-term survival were evaluated using the Cox proportional hazard model.


RESULTS
The degree of specialization of the operating surgeon had no significant effect on long-term survival. When comparing the surgeons with the highest degree of specialization, noncolorectal surgeons demonstrated a slightly lower long-term survival for rectal cancer stage I and II (HR, 2.03; 95% CI, 1.05-3.92). Surgeons with a high case-load were not associated with better survival in any analysis model. Regional hospitals had a lower survival rate for rectal cancer stage III surgery (HR, 1.47; 95% CI, 1.08-2.00).


CONCLUSIONS
Degree of specialization, surgeon case-load and hospital category could not be identified as important factors when determining outcome in colorectal cancer surgery in this study.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. fredrik.brannstrom@karolinska.se
F
F
Brännström
P
P
Jestin
P
P
Matthiessen
U
U
Gunnarsson
D002983:Clinical Competence; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D006761:Hospitals / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012042:Registries; D012307:Risk Factors; D013038:Specialization / Q000706:statistics & numerical data*; D013548:Sweden; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data*