Department of Surgery, Galway Clinic, Galway, Ireland.
Royal College of Surgeons in Ireland, Dublin, Ireland.
Ir J Med Sci. 2023 Dec;192(6):2673-2679. doi: 10.1007/s11845-023-03372-z. Epub 2023 May 8.
The centralisation of rectal cancer management to high-volume oncology centres has translated to improved oncological and survival outcomes. We hypothesise that individual surgeon caseload, specialisation, and experience may be as significant in determining oncologic and postoperative outcomes in rectal cancer surgery.
A prospectively maintained colorectal surgery database was reviewed for patients undergoing rectal cancer surgery between January 2004 and June 2020. Data studied included demographics, Dukes' and TNM staging, neoadjuvant treatment, preoperative risk assessment scores, postoperative complications, 30-day readmission rates, length of stay (LOS), and long-term survival. Primary outcome measures were 30-day mortality and long-term survival compared to national and international standards and best practice guidelines.
In total, 87 patients were included (mean age: 66 years [range: 36-88]). The mean length of stay (LOS) was 16.5 days (SD 6.0). The median ICU LOS was 3 days (range 2-17). Overall, 30-day readmission rate was 16.4%. Twenty-four patients (26.4%) experienced ≥ 1 postoperative complication. The 30-day operative mortality rate was 3.45%. Overall 5-year survival rate was 66.6%. A significant correlation was observed between P-POSSUM scores and postoperative complications (p = 0.041), and all four variants of POSSUM, CR-POSSUM, and P-POSSUM scores and 30-day mortality.
Despite improved outcomes seen with centralisation of rectal cancer services at an institutional level, surgeon caseload, experience, and specialisation is of similar importance in obtaining optimal outcomes within institutions.
直肠癌管理向高容量肿瘤中心的集中化已经转化为改善的肿瘤学和生存结果。我们假设，在直肠癌手术中，个体外科医生的手术量、专业化和经验可能与肿瘤学和术后结果同样重要。
回顾了 2004 年 1 月至 2020 年 6 月期间接受直肠癌手术的患者的前瞻性维护的结直肠外科手术数据库。研究的数据包括人口统计学、Dukes 和 TNM 分期、新辅助治疗、术前风险评估评分、术后并发症、30 天再入院率、住院时间（LOS）和长期生存。主要结局测量指标是与国家和国际标准和最佳实践指南相比的 30 天死亡率和长期生存。
总共纳入了 87 例患者（平均年龄：66 岁[范围：36-88 岁]）。平均住院时间（LOS）为 16.5 天（SD 6.0）。中位数 ICU LOS 为 3 天（范围 2-17）。总体而言，30 天再入院率为 16.4%。24 例（26.4%）患者经历了≥1 种术后并发症。30 天手术死亡率为 3.45%。总体 5 年生存率为 66.6%。P-POSSUM 评分与术后并发症之间存在显著相关性（p=0.041），以及所有四种 POSSUM、CR-POSSUM 和 P-POSSUM 评分与 30 天死亡率之间存在显著相关性。
尽管直肠癌服务在机构层面上的集中化带来了改善的结果，但外科医生的手术量、经验和专业化在机构内获得最佳结果方面同样重要。
