Dorrance H R, Docherty G M, O'Dwyer P J
University Department of Surgery, Western Infirmary, Glasgow, United Kingdom.
Dis Colon Rectum. 2000 Apr;43(4):492-8. doi: 10.1007/BF02237192.
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.
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.
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.
These data show that surgeons with an interest in colorectal cancer achieve lower local and overall recurrence rates compared 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.
在结直肠癌根治性手术后，患者的预后存在显著差异，这与实施手术的外科医生有关。这些差异的原因仍不清楚。本研究的目的是探讨外科医生的专业对结直肠癌根治性手术后患者预后的影响，并确定可能有助于解释不同专业组预后差异的因素。
1990年至1993年间，在一家大型教学医院，378例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）实施的结直肠癌根治性手术。收集了手术细节信息，包括切除标本的长度、切缘、肿瘤是否与相邻临床受累器官整块切除、切除的淋巴结数量以及分期。使用逻辑回归分析在单变量和多变量水平上分析影响局部和总体复发率的因素。
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，0.56；95%置信区间，0.31 - 0.99）和结直肠专业（P = 0.04）。由普通外科医生手术的患者发生局部复发的可能性是由结直肠外科医生手术患者的3.42倍（95%置信区间，1.32 - 8.9）。对于总体复发，多变量分析显示早期疾病（P < 0.0001）、无血管侵犯（0.005）和结直肠专业（0.025）是与显著改善的预后相关的唯一因素。
这些数据表明，与血管或移植外科医生或普通外科医生相比，对结直肠癌感兴趣的外科医生实现了更低的局部和总体复发率。局部复发率的差异似乎主要与所进行的切除范围有关，并表明在进行结直肠癌根治性手术时需要切除足够的标本。
