This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Influence of volume and specialization on survival following surgery for colorectal cancer. BJS 2004; 91: 610-617.
Published: 16th March 2004
Authors: C. S. McArdle, D. J. Hole
Background
Previous studies have shown that significant surgeon‐related differences in survival exist following surgery for colorectal cancer. It is not clear whether these differences were due to differences in caseload or degree of specialization.
Method
Outcome in 3200 patients who underwent resection for colorectal cancer between 1991 and 1994 was analysed on the basis of caseload and degree of specialization of individual surgeons. Five‐year survival rates, and the corresponding hazard ratios adjusted for case mix, were calculated.
Results
Cancer‐specific survival rate at 5 years following curative resection varied among surgeons from 53·4 to 84·6 per cent; the adjusted hazard ratios varied from 0·48 to 1·55. Cancer‐specific survival rate at 5 years following curative resection was 70·2, 62·0 and 65·9 per cent for surgeons with a high, medium and low case volume respectively. There were no consistent differences in the adjusted hazard ratios by volume. Cancer‐specific survival rate at 5 years following curative resection was 72·7 per cent for those treated by specialists and 63·8 per cent for those treated by non‐specialists; the adjusted hazard ratio for non‐specialists was 1·35 (95 per cent confidence interval 1·13 to 1·62; P = 0·001).
Conclusion
The differences in outcome following apparently curative resection for colorectal cancer among surgeons appear to reflect the degree of specialization rather than case volume. It is likely that increased specialization will lead to further improvements in survival. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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