Surgeon-related factors and outcome in rectal cancer
Surgeon-related factors and outcome in rectal cancer
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DOI：
10.1097/00000658-199802000-00001
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发表时间：
1998-02-01
影响因子：
9
通讯作者：
Newman, SC
中科院分区：
文献类型：
--
作者：
Porter, GA;Soskolne, CL;Newman, SC
目的探讨结直肠外科亚专科培训或外科医生直肠癌切除频率是否为局部复发（LR）和生存的独立预后因素。背景资料直肠癌患者预后在各中心和个别外科医生之间存在差异。然而，外科相关因素对预后的重要性在很大程度上是未知的。方法回顾性分析1983 ~ 1990年在埃德蒙顿五所综合医院接受有治愈潜力的低位前切除术或腹会阴切除术的原发性直肠腺癌患者。获得术前、术中、病理、辅助治疗和结局变量。关注的结果包括LR和疾病特异性生存（DSS）。为了确定生存率并控制混杂因素和相互作用，采用CoX比例风险回归进行多因素分析。结果纳入683例患者，52名外科医生，663例（97%）患者随访5年。有5名受过结肠直肠培训的外科医生进行了109例（16%）手术。独立于外科医生的培训，在研究期间，323例手术（47%）是由外科医生完成的< 21例直肠癌切除术。多因素分析显示，未受过结直肠手术训练的外科医生（HR = 2.5, p = 0.001）和手术次数< 21次的外科医生（HR = 1.8, p < 0.001）的患者发生LR的风险均增加。分期（p < 0.001）、使用辅助治疗（p = 0.002）、直肠穿孔或肿瘤外溢（p < 0.001）和血管/神经侵犯（p = 0.002）也是LR的重要预后因素。同样，疾病特异性生存率的降低与未受过结直肠培训的外科医生（HR = 1.5, p = 0.03）和外科医生的表现独立相关
ObjectiveTo determine whether surgical subspecialty training in colorectal surgery or frequency of rectal cancer resection by the surgeon are independent prognostic factors for local recurrence (LR) and survival.Summary Background DataVariation in patient outcome in rectal cancer has been shown among centers and among individual surgeons. However, the prognostic importance of surgeon-related factors is largely unknown.MethodsAll patients undergoing potentially curative low anterior resection or abdominoperineal resection for primary adenocarcinoma of the rectum between 1983 and 1990 at the five Edmonton general hospitals were reviewed in a historic-prospective study design. Preoperative, intraoperative, pathologic, adjuvant therapy, and outcome variables were obtained. Outcomes of interest included LR and disease-specific survival (DSS). To determine survival rates and to control both confounding and interaction, multivariate analysis was performed using CoX proportional hazards regression.ResultsThe study included 683 patients involving 52 surgeons, with >5-year follow-up obtained on 663 (97%) patients. There were five colorectal-trained surgeons who performed 109 (16%) of the operations. independent of surgeon training, 323 operations (47%) were done by surgeons performing < 21 rectal cancer resections over the study period. Multivariate analysis showed that the risk of LR was increased in patients of both noncolorectal trained surgeons (hazard ratio (HR) = 2.5, p = 0.001) and those of surgeons performing < 21 resections (HR = 1.8, p < 0.001). Stage (p < 0.001), use of adjuvant therapy (p = 0.002), rectal perforation or tumor spill (p < 0.001), and vascular/neural invasion (p = 0.002) also were significant prognostic factors for LR. Similarly, decreased disease-specific survival was found to be independently associated with noncolorectal-trained surgeons (HR = 1.5, p = 0.03) and surgeons performing