title: The impact of surgical specialisation on survival following elective colon cancer surgery.
abstract: OBJECTIVE
  Reorganisation of cancer services in the UK and across Europe has led to elective surgery for colon cancer being increasingly, but not exclusively, delivered by specialist colorectal surgeons. This study examines survival after elective colon cancer surgery performed by specialist compared to non-specialist surgeons.
  
  
  METHODS
  Patients undergoing elective surgery for colon cancer in 16 hospitals between 2001 and 2004 were identified from a prospectively maintained regional audit database. Post-operative mortality (<30 days) and 5-year relative survival in those receiving surgery under the care of a specialist or non-specialist surgeon were compared.
  
  
  RESULTS
  A total of 1,856 patients were included, of which, 1,367 (73.7%) were treated by a specialist and 489 (26.4%) by a non-specialist surgeon. Those treated by a specialist were more likely to be deprived, undergo surgery in a high volume unit and have higher lymph node yields than those treated by a non-specialist. Post-operative mortality was lower (4.5 versus 7.0%; P = 0.032) and 5-year relative survival was higher (72.2 versus 65.6%; P = 0.012) among those treated by a specialist surgeon. In multivariate analysis, surgery by non-specialists was independently associated with increased post-operative mortality (adjusted odds ratio (OR) 1.69; P < 0.001) and poorer 5-year relative survival (adjusted relative excess risk (RER) 1.17; P = 0.045). After exclusion of post-operative deaths, there was no difference in long-term survival (adjusted RER 1.08; P = 0.505).
  
  
  CONCLUSIONS
  Five-year relative survival after elective colon cancer surgery was higher among those treated by specialist colorectal surgeons due to increased post-operative mortality among those treated by non-specialists.
authors.affiliation: University Department of Surgery, Faculty of Medicine, University of Glasgow, 4th Floor Walton Building, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK, raymondoliphant@nhs.net.
authors.forename: Raymond
authors.initials: R
authors.lastname: Oliphant
authors.forename: Gary A
authors.initials: GA
authors.lastname: Nicholson
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
authors.forename: David S
authors.initials: DS
authors.lastname: Morrison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012606:Scotland / Q000453:epidemiology; D012959:Socioeconomic Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult