title: The positive impact of surgeon specialization on survival for gastric cancer patients after surgery with curative intent.
abstract: BACKGROUND
  Many studies have affirmed the survival benefit for cancer patients treated by specialized surgeons.
  
  
  METHODS
  A total of 967 patients with gastric cancer (GC) who underwent gastrectomy with curative intent in our center were enrolled. Patients were categorized into two groups based on surgeon specialization: the specialized group (SG) and nonspecialized group (NSG). To overcome bias due to the different distribution of covariates for the two groups, a one-to-one match was applied using propensity score analysis. After matching, prognosis and recurrence data were analyzed.
  
  
  RESULTS
  After one-to-one matching, 261 patients in the SG and 261 patients in the NSG had the same characteristics excluding factors associated with surgery. In multivariate analysis for the whole study series, surgeon specialization was an independent prognostic factor for GC patients after surgery. Patients in the SG demonstrated a significantly higher 5-year overall survival than those in the NSG (50.7 vs. 37.2 %, p = 0.001). With the strata analysis, significant prognostic differences between the two groups were only observed in patients at stage IIIa-b or N1-2. The proportion of locoregional recurrence was greater in the NSG than in the SG.
  
  
  CONCLUSIONS
  GC patients treated by specialized surgeons tended to have a better prognosis and lower locoregional recurrence rate. Surgeon specialization was an independent prognostic factor for GC patients after surgery. GC should be treated by specialized surgeons in large-volume centers.
authors.affiliation: Department of Gastric Cancer, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.
authors.forename: Yuexiang
authors.initials: Y
authors.lastname: Liang
authors.affiliation: Department of Gastric Cancer, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.
authors.forename: Liangliang
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of Gastric Cancer, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.
authors.forename: Xiaona
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Gastric Cancer, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.
authors.forename: Xuewei
authors.initials: X
authors.lastname: Ding
authors.affiliation: Department of Gastric Cancer, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China. prof_lianghan@126.com.
authors.forename: Han
authors.initials: H
authors.lastname: Liang
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005260:Female; D005743:Gastrectomy; D005762:Gastroenterology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D013038:Specialization; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D066231:Surgeons; D016896:Treatment Outcome
keywords: Gastric carcinoma; Prognosis; Recurrence; Surgeon specialization