title: Surgical training on rectal cancer surgery: do supervised senior residents differ from consultants in outcomes?
abstract: BACKGROUND
  The present work is a comparative study to investigate the independent effect of tutored senior residents on rectal cancer surgery in an academic university hospital. The variable "surgeon" is held to be a major determinant of outcome following total mesorectal excision (TME) for rectal cancer.
  
  
  OBJECTIVE
  We hypothesized that TME can be tutored to senior surgical residents without compromising surgical and oncological outcomes.
  
  
  METHODS
  Demographics, preoperative characteristics, and surgical data from consecutive patients undergoing elective TME in an academic center over the last decade were retrospectively reviewed from a prospectively collected database. Outcomes were compared in the two cohorts by a principal surgeon (senior resident or staff) and supervised in all cases by a senior colorectal consultant. Association of outcome variables with the type of surgeon was determined by univariate and multivariate analyses and results were corrected by tumor's height.
  
  
  RESULTS
  A total of 230 patients were treated over the study period; 136 (59 %) surgeries were performed by staff surgeons (group S) and 94 (41 %) by residents (group R). Both groups were comparable except for distance to anal verge; staff surgeons operated on lower tumors and performed a high percentage of coloanal anastomosis. There were no statistical differences between groups in terms of surgical and oncological outcomes when tumors were located over 7 cm from the anal verge.
  
  
  CONCLUSIONS
  Rectal surgery can be performed by senior residents with equal results to staff surgeons when there is direct supervision by a senior consultant and when the tumor is located in the mid-upper rectum (>7 cm from the anal verge). For lower tumors, a careful selection must be made as the operation may require a higher level of training.
authors.affiliation: Department of Surgery, Division of Colorectal Surgery, Hospital Fundación Jiménez-Díaz, Universidad Autónoma de Madrid, Reyes Católicos Ave. # 2, 28040 Madrid, Spain. cpastorid@fjd.es
authors.forename: Carlos
authors.initials: C
authors.lastname: Pastor
authors.forename: Javier A
authors.initials: JA
authors.lastname: Cienfuegos
authors.forename: Jorge
authors.initials: J
authors.lastname: Baixauli
authors.forename: Jorge
authors.initials: J
authors.lastname: Arredondo
authors.forename: Jesus J
authors.initials: JJ
authors.lastname: Sola
authors.forename: Carmen
authors.initials: C
authors.lastname: Beorlegui
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Hernandez-Lizoain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003253:Consultants; D013505:Digestive System Surgical Procedures / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome