Department of Surgery, St Mary's Hospital, Imperial College, Praed Street, London, W2 1NY, UK,
Surg Endosc. 2014 Jan;28(1):134-42. doi: 10.1007/s00464-013-3139-5. Epub 2013 Sep 20.
This study aimed to evaluate using national data the role of surgeon laparoscopic caseload in determining outcome following elective laparoscopic colorectal cancer resection.
All patients who underwent an elective laparoscopic primary colorectal cancer resection between 2002 and 2008 were included from the Hospital Episode Statistics database. Surgeon teams were divided into tertiles according to the mean laparoscopic caseload per year. High volume corresponded to more than 12 laparoscopic procedures per year and low volume corresponded to seven or fewer procedures per year. Outcome measures were 30-day in-hospital mortality, return to theatre (RTT), 30-day medical morbidity, 365-day medical morbidity, length of stay (LOS), and unplanned 28-day readmission.
There was a significant increase in the number of surgeons selecting patients for the laparoscopic approach between 2002-2003 and 2007-2008. In 2002-2003, a total of 41 surgeon teams performed laparoscopic resections whereas in 2007-2008 there were 398 surgeon teams. The patients of high-volume surgeon teams had a shorter LOS [OR 0.88 (0.85-0.91), p < 0.0001]. Patients of medium-volume surgeon teams had the highest medical morbidity rates [30-day medical morbidity: OR 1.24 (1.04-1.48), p = 0.015; 365-day medical morbidity: OR 1.22 (1.04-1.45), p = 0.018]. There were no differences between the high- and low-volume groups in terms of mortality, morbidity, RTT, or readmission.
Although there has been a significant increase in the number of surgeon teams offering the minimal access approach, this study has not found a consistent relationship between surgeon laparoscopic cancer surgery caseload and outcome.
WHAT'S NEW IN THIS MANUSCRIPT: This is the first national study to explore the role of surgical volume in determining outcome following laparoscopic surgery. This study questions the impact of surgeon caseload on laparoscopic surgical outcome.
本研究旨在利用国家数据评估外科医生腹腔镜手术量在决定择期腹腔镜结直肠肿瘤切除术后结果中的作用。
从医院病例统计数据库中纳入 2002 年至 2008 年间接受择期腹腔镜原发性结直肠癌切除术的所有患者。根据每年腹腔镜手术的平均例数，将外科医生团队分为三分位。高容量对应每年超过 12 例腹腔镜手术，低容量对应每年 7 例或更少。结果指标为 30 天住院内死亡率、重返手术室（RTT）、30 天医疗发病率、365 天医疗发病率、住院时间（LOS）和计划外 28 天再入院。
选择腹腔镜治疗的外科医生数量从 2002-2003 年到 2007-2008 年之间有显著增加。2002-2003 年，共有 41 个外科医生团队进行腹腔镜切除术，而在 2007-2008 年则有 398 个外科医生团队。高容量外科医生团队的患者 LOS 更短[比值比（OR）0.88（0.85-0.91），p < 0.0001]。中容量外科医生团队的患者发病率最高[30 天医疗发病率：OR 1.24（1.04-1.48），p = 0.015；365 天医疗发病率：OR 1.22（1.04-1.45），p = 0.018]。高容量和低容量组之间在死亡率、发病率、RTT 或再入院方面没有差异。
尽管提供微创方法的外科医生团队数量显著增加，但本研究并未发现外科医生腹腔镜癌症手术量与结果之间存在一致关系。
这是第一项探索手术量在决定腹腔镜手术后结果中的作用的全国性研究。本研究质疑了外科医生手术量对腹腔镜手术结果的影响。
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