外科医生的知识有助于解释外科医生手术量与直肠癌患者预后之间的关系。

Surgeon knowledge contributes to the relationship between surgeon volume and patient outcomes in rectal cancer.

机构信息

Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.

出版信息

Ann Surg. 2013 Feb;257(2):295-301. doi: 10.1097/SLA.0b013e31825ffdca.

DOI:10.1097/SLA.0b013e31825ffdca

PMID:22968065

Abstract

OBJECTIVE

To determine whether surgeon knowledge contributes to the relationship between surgeon procedure volume and patient outcomes in rectal cancer.

BACKGROUND

Although previous research has shown that treatment by high-volume surgeons is associated with improved outcomes among patients with rectal cancer, the mechanisms for such an association are not well understood.

METHODS

In 2009, a mail survey with 8 questions pertaining to rectal cancer care was created, modified for content validity, and sent to all general surgeons in Nova Scotia, Canada. Patients with rectal cancer, who were treated by the survey respondents between July 1, 2002, and June 30, 2006, were identified retrospectively, and a comprehensive standardized review of medical records was used to collect outcome data for this population-based cohort. The association between surgeon survey score (dichotomized into high- and low-score groups on the basis of the median score), surgeon procedure volume, and patient outcomes was examined.

RESULTS

Of 521 patients who underwent treatment with curative intent from July 1, 2002, to June 30, 2006, 377 patients (72%) were treated by 25 surgeons who responded to the survey. After controlling for patient and tumor factors, patients treated by high-volume surgeons were more likely to receive a total mesorectal excision (TME) [odds ratio (OR) = 3.89; 95% confidence interval (CI), 2.20-5.83], more likely to undergo an adequate lymph node harvest (OR = 3.67; 95%CI, 2.36-5.70), less likely to have a permanent colostomy (OR = 0.53; 95%CI, 0.30-0.93), and less likely to develop local recurrence (HR = 0.54; 95%CI, 0.29-0.99). When surgeon survey score was included in the multivariate regression models, the relationship between surgeon procedure volume and permanent colostomy was diminished. There was a significant interaction between surgeon survey score and surgeon volume for the outcomes of use of TME (P < 0.01) and local recurrence (P = 0.01).

CONCLUSIONS

These data suggest that surgeon knowledge may, at least in part, explain surgeon volume-associated differences in rectal cancer outcomes.

摘要

目的

确定外科医生的知识是否有助于直肠癌中外科医生手术量与患者结果之间的关系。

背景

尽管先前的研究表明，高容量外科医生的治疗与直肠癌患者的改善结果相关，但这种关联的机制尚不清楚。

方法

2009 年，创建了一项包含 8 个与直肠癌护理相关问题的邮件调查，该调查经过内容有效性修改后发送给加拿大新斯科舍省的所有普通外科医生。回顾性地确定了在 2002 年 7 月 1 日至 2006 年 6 月 30 日期间接受调查受访者治疗的直肠癌患者，并使用全面标准化的病历审查来收集该基于人群队列的结果数据。检查了外科医生调查评分（根据中位数评分将其分为高分和低分组）、外科医生手术量和患者结果之间的关联。

结果

在 2002 年 7 月 1 日至 2006 年 6 月 30 日期间接受根治性治疗的 521 名患者中，有 377 名（72%）接受了对调查做出回应的 25 名外科医生的治疗。在控制了患者和肿瘤因素后，接受高容量外科医生治疗的患者更有可能接受全直肠系膜切除术（TME）[优势比（OR）=3.89；95%置信区间（CI），2.20-5.83]，更有可能进行充分的淋巴结清扫（OR=3.67；95%CI，2.36-5.70），不太可能发生永久性结肠造口术（OR=0.53；95%CI，0.30-0.93），并且不太可能发生局部复发（HR=0.54；95%CI，0.29-0.99）。当将外科医生调查评分纳入多元回归模型时，外科医生手术量与永久性结肠造口术之间的关系减弱。TME 的使用（P<0.01）和局部复发（P=0.01）的结果与外科医生调查评分和外科医生量之间存在显著的相互作用。