title: The challenge of education in colorectal cancer surgery: a comparison of early oncological results, morbidity, and mortality between residents and attending surgeons performing an open right colectomy.
abstract: OBJECTIVE
  Ongoing education in surgical oncology is mandatory in a modern residency program. Achieving acceptable morbidity and mortality rates, together with oncological adequacy, is mandatory. The aim of the study was to compare early surgical outcomes in 2 groups of patients, those operated on by a surgical resident supervised by an attending surgeon and those operated on by 2 attending surgeons.
  
  
  METHODS
  Data from consecutive patients with right colon cancer undergoing a right hemicolectomy were collected and analyzed. The patients were divided into 2 groups according to the surgeons' credentials: residents supervised by an attending surgeon and 2 attending surgeons. To evaluate the specific case mix of the 2 groups, the Portsmouth-Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (P-POSSUM) was calculated. Observed over expected 30-day morbidity and mortality rates were compared for the 2 groups. The number of lymph nodes retrieved was chosen to determine oncological appropriateness. Duration of the procedures was also recorded.
  
  
  RESULTS
  From January 2008 to January 2012, 139 patients underwent an right hemicolectomy (76 resections performed by surgical residents and 63 by attending surgeons). Patient characteristics according to the P-POSSUM score and cancer stage were equivalent in the 2 groups. Observed over expected mortality and morbidity rates according to P-POSSUM were 0%/3.5% and 21.6%/40.5%, respectively, for the resident group (p = nonsignificant, p = 0.01) and 4.7%/5.8% and 25.4%/42.9%, respectively, for the attending surgeons (p = nonsignificant). The node count was 23.6 nodes for residents and 23.1 for the attending surgeons. The length of surgery was 159.9 minutes vs 159.4 minutes for residents and attending surgeons, respectively.
  
  
  CONCLUSIONS
  Surgical oncology training of residents by expert surgeons cannot put patient's safety at risk. Our study showed that oncological accuracy and the 30-day complication rate were equivalent to the standard of care in both groups. Duration of the procedure was not affected by the presence of a trainee.
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy. Electronic address: isacmontroni@yahoo.com.
authors.forename: Isacco
authors.initials: I
authors.lastname: Montroni
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Ghignone
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Rosati
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Zattoni
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Manaresi
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Taffurelli
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Ugolini
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016896:Treatment Outcome
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Professionalism; length of surgery; lymph nodes; outcomes; surgical oncology; training