Buurma Marleen, Kroon Hidde M, Reimers Marlies S, Neijenhuis Peter A
Department of Surgery, Alrijne Hospital, Location Leiderdorp, Simon Smitweg 1, 2353 GA Leiderdorp, Netherlands.
Department of Surgery, Alrijne Hospital, Location Leiderdorp, Simon Smitweg 1, 2353 GA Leiderdorp, Netherlands ; Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.
Int J Surg Oncol. 2015;2015:464570. doi: 10.1155/2015/464570. Epub 2015 Sep 3.
Surgery performed by a high-volume surgeon improves short-term outcomes. However, not much is known about long-term effects. Therefore we performed the current study to evaluate the impact of high-volume colorectal surgeons on survival.
We conducted a retrospective analysis of our prospectively collected colorectal cancer database between 2004 and 2011. Patients were divided into two groups: operated on by a high-volume surgeon (>25 cases/year) or by a low-volume surgeon (<25 cases/year). Perioperative data were collected as well as follow-up, recurrence rates, and survival data.
774 patients underwent resection for colorectal malignancies. Thirteen low-volume surgeons operated on 453 patients and 4 high-volume surgeons operated on 321 patients. Groups showed an equal distribution for preoperative characteristics, except a higher ASA-classification in the low-volume group. A high-volume surgeon proved to be an independent prognostic factor for disease-free survival in the multivariate analysis (P = 0.04). Although overall survival did show a significant difference in the univariate analysis (P < 0.001) it failed to reach statistical significance in the multivariate analysis (P = 0.09).
In our study, a higher number of colorectal cases performed per surgeon were associated with longer disease-free survival. Implementing high-volume surgery results in improved long-term outcome following colorectal cancer.
由高手术量外科医生实施的手术可改善短期预后。然而，对于长期影响知之甚少。因此，我们开展了本研究以评估高手术量结直肠外科医生对生存率的影响。
我们对2004年至2011年期间前瞻性收集的结直肠癌数据库进行了回顾性分析。患者分为两组：由高手术量外科医生（每年>25例）或低手术量外科医生（每年<25例）进行手术。收集围手术期数据以及随访、复发率和生存数据。
774例患者接受了结直肠恶性肿瘤切除术。13名低手术量外科医生为453例患者实施了手术，4名高手术量外科医生为321例患者实施了手术。两组术前特征分布均衡，但低手术量组的美国麻醉医师协会（ASA）分级较高。在多变量分析中，高手术量外科医生被证明是无病生存的独立预后因素（P = 0.04）。虽然总生存在单变量分析中显示出显著差异（P < 0.001），但在多变量分析中未达到统计学意义（P = 0.09）。
在我们的研究中，每位外科医生实施的结直肠手术例数较多与更长的无病生存期相关。实施高手术量手术可改善结直肠癌后的长期预后。
