O Stoma Mia wrote:NHMike wrote:Learning Curve: The Surgeon as a Prognostic Factor in Colorectal Cancer Surgery (2005)
Thirteen consultants, none of whom had a special interest in colorectal surgery, operated on 645 patients with colorectal cancer. Outcome differed tremendously between the individual surgeons. The rate of curative resection varied from 40% to 76%, postoperative mortality from 0% to 20%, local recurrence from 0% to 21%, anastomotic leakage from 0% to 25%, and survival at 10 years from 20% to 63%. These important differences in outcome were not entirely explained by differences in patient population (case-mix, e.g., more advanced tumor stage). The existence of a significant
inter-surgeon variability was hereby proven. The individual surgeon was later identified as an independent prognostic factor for the frequency of locoregional recurrence and survival in rectal cancer patients by applying multiple logistic regression analysis adjusting for case mix differences (Hermanek et al. 1995). A great number of publications followed, investigating the prognostic role of the surgeon as well as of surgeon- and hospital-related factors (e.g., board certification, subspecialty training, annual caseload, teaching status). Most tumor-related, patient-related, and treatment-related predictors of outcome cannot be altered. The majority of surgeon- and hospital-related factors, however, can be influenced positively. Herein lies great promise, since an enhancement of surgeon and hospital related factors will lead to a significant improvement in the patient’s outcome.
Thanks for posting this. This is a very important finding, especially for the case of rectal cancer surgeons.
And people don't seem to value expertise to an extent anymore.. I would only want an experienced colorectal surgeon (board-cert) at a high-volume center to do my surgery. Everything in that paper points to more experience = better short and long-term patient outcomes. I doubt this has changed in the last 10 years either! Thanks for sharing.