title: Improving the quality of colon cancer surgery through a surgical education program.
abstract: OBJECTIVE
  Recent evidence has demonstrated the importance of dissection in the correct tissue plane for the resection of colon cancer. We have previously shown that meticulous mesocolic plane surgery yields better outcomes and that the addition of central vascular ligation produces an oncologically superior specimen compared with standard techniques. We aimed to assess the effect of surgical education on the oncological quality of the resection specimen produced.
  
  
  METHODS
  We received clinicopathological data and specimen photographs from 263 resections for primary colon cancer from 6 hospitals in the Capital and Zealand regions of Denmark before a national training program. Ninety-three cases were from Hillerød Hospital, where surgeons had previously implemented a surgical educational training program in complete mesocolic excision with central vascular ligation and adopted the procedure as standard practice. The specimen photographs were assessed for the plane of surgery and tissue morphometry was performed.
  
  
  RESULTS
  Hillerød specimens had a higher rate of mesocolic plane surgery (75% vs 48%; P < .0001) compared with the other hospitals. The surgeons at Hillerød Hospital also removed a greater length of colon in both fresh (median, 315 vs 247 mm; P < .0001) and fixed (269 vs 207 mm; P < .0001) specimens with a greater distance between the tumor and the closest vascular tie in both fresh (105 vs 84 mm; P = .006) and fixed (82 vs 67 mm; P = .002) specimens. This resulted in the removal of more mesentery in both fresh (14,466 vs 8706 mm; P < .0001) and fixed (9418 vs 6789 mm; P < .0001) specimens and a greater median lymph node yield (28 vs 18; P < .0001).
  
  
  CONCLUSIONS
  We have shown that adoption of complete mesocolic excision with central vascular ligation results in a change to the production of an oncologically superior specimen compared with standard techniques. This should improve outcomes toward those reported by centers that have long practiced meticulous colon cancer surgery.
authors.affiliation: Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, Leeds, United Kingdom. n.p.west@leeds.ac.uk
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: West
authors.forename: Kate M
authors.initials: KM
authors.lastname: Sutton
authors.forename: Peter
authors.initials: P
authors.lastname: Ingeholm
authors.forename: Rikke H
authors.initials: RH
authors.lastname: Hagemann-Madsen
authors.forename: Werner
authors.initials: W
authors.lastname: Hohenberger
authors.forename: Philip
authors.initials: P
authors.lastname: Quirke
mesh_terms: D002983:Clinical Competence; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery / Q000193:education* / Q000592:standards; D003718:Denmark; D004502:Education, Medical, Continuing; D006801:Humans; D010781:Photography; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D018709:Statistics, Nonparametric