Effect of surgeon specialty interest on patient outcome after potentially curative colorectal cancer surgery
Effect of surgeon specialty interest on patient outcome after potentially curative colorectal cancer surgery
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DOI：
10.1007/bf02237192
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发表时间：
2000-04-01
影响因子：
3.9
通讯作者：
O'Dwyer, PJ
中科院分区：
文献类型：
--
作者：
Dorrance, HR;Docherty, GM;O'Dwyer, PJ
目的：有可能治愈的大肠癌手术后患者的预后有显著差异，这与外科医生进行手术有关。造成这些差异的原因尚不清楚。本研究的目的是检查外科医生的专业对可能治愈的结直肠癌手术后患者预后的影响，并确定可能有助于解释专业组之间预后差异的因素。方法：1990年至1993年间，在一家大型教学医院，378名患者接受了由不同专业兴趣的外科医生（血管或移植外科医生、普通外科医生和结直肠外科医生）进行的有治愈潜力的结直肠癌手术。收集手术细节信息，包括切除标本的长度、切除边缘、是否切除肿瘤并整体切除邻近的临床受累器官、切除的淋巴结数量和分期。在单因素和多因素水平上使用logistic回归分析影响局部和总体复发率的因素。结果：在中位随访45个月时，与局部复发率显著降低相关的唯一因素是切除标本的长度（优势比为0.56；95%可信区间为0.31-0.99）和结直肠专科（P = 0.04）。由普通外科医生进行手术的患者发生局部复发的可能性是由结直肠外科医生进行手术的患者的3.42倍（95%可信区间，1.32-8.9）。在多因素分析中，对于总复发，早期疾病（P < 0.0001）、没有血管侵犯（0.005）和结直肠专科（0.025）是唯一与预后显著改善相关的因素。结论：这些数据表明，与血管、移植或普通外科医生相比，结肠直肠癌外科医生的局部和总体复发率较低。局部复发率的差异似乎主要与切除的程度有关，并证明在进行可能治愈的结直肠癌手术时需要切除足够的标本。
OBJECTIVE: There are significant differences in patient outcome after potentially curative surgery for colorectal cancer that relate to the surgeon performing the procedure. The reasons for these differences remain obscure. The aim of this study was to examine the effect of the surgeon's specialty on patient outcome after potentially curative colorectal cancer surgery and to identify factors that may help explain differences in outcome among specialty groups. METHODS: Between 1990 and 1993, 378 patients underwent potentially curative surgery for colorectal cancer by surgeons with different specialty interests, vascular or transplant, general, and colorectal surgeons, in a large teaching hospital. Information on operative details, including the length of the resection specimen, resection margins, whether the tumor was removed with en bloc resection of adjacent clinically involved organs, number of lymph nodes removed, and stage was collected. Factors affecting both local and overall recurrence rates were analyzed using logistic regression analysis at both univariate and multivariate levels. RESULTS: At a median follow-up of 45 months the only factors associated with a significantly reduced local recurrence rate were the length of the resection specimen (odds ratio, 0.56; 95 percent confidence interval, 0.31-0.99) and colorectal specialty (P = 0.04). Patients operated on by a general surgeon were 3.42 times (95 percent confidence interval, 1.32-8.9) more likely to develop a local recurrence than those operated on by a colorectal surgeon. For overall recurrence, early stage disease (P < 0.0001), absence of vascular invasion (0.005), and colorectal specialty (0.025) were the only factors associated with significantly improved outcome at multivariate analysis. CONCLUSIONS: These data show that surgeons with an interest in colorectal cancer achieve lower local and overall recurrence rates com pared with vascular or transplant or general surgeons. Differences in local recurrence rates seem to be predominantly related to the extent of resection performed and demonstrate the need to remove an adequate specimen when Performing potentially curative colorectal cancer surgery.