Influence of volume and specialization on survival following surgery for colorectal cancer
Influence of volume and specialization on survival following surgery for colorectal cancer
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DOI：
10.1002/bjs.4476
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发表时间：
2004-05-01
影响因子：
9.6
通讯作者：
Hole, DJ
中科院分区：
文献类型：
--
作者：
McArdle, CS;Hole, DJ
背景：先前的研究表明，结直肠癌手术后存在显著的手术相关生存差异。目前尚不清楚这些差异是否是由于案件量或专业化程度的差异。根据病例量和外科医生的专业化程度，对1991年至1994年间3200例结直肠癌切除术患者的结局进行了分析。五年的生存率，并相应的风险比调整的情况下mixtured，calculated.Results：癌症特异性生存率在5年后根治性切除术之间的外科医生从53.4%到84.6%不等，调整后的风险比从0.48到1.55不等。高、中和低病例量外科医生在根治性切除术后5年的癌症特异性生存率分别为70.2%、62.0%和65.9%。按体积计算的调整后风险比无一致差异。接受专家治疗的患者和接受非专家治疗的患者在根治性切除术后5年的癌症特异性生存率分别为72.7%和63.8%;非专家治疗的校正风险比为1.35（95%置信区间为1.13至1.62; P = 0.001）。外科医生之间结直肠癌明显治愈性切除术后结果的差异似乎反映了专业化程度，而不是病例数量。专业化程度的提高很可能会导致生存率的进一步提高。
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.Methods. 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.