Schuld Gabor J, Schlager Lukas, Monschein Matthias, Riss Stefan, Bergmann Michael, Razek Peter, Stift Anton, Unger Lukas W
Division of Visceral Surgery, Dept. of General Surgery, Medical University of Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Hospital Floridsdorf, Department of General Surgery, Brünner Straße 68, 1221, Vienna, Austria.
Wien Klin Wochenschr. 2025 Apr;137(7-8):231-236. doi: 10.1007/s00508-024-02405-6. Epub 2024 Aug 2.
A clear relationship between higher surgeon volume and improved outcomes has not been convincingly established in rectal cancer surgery. The aim of this study was to evaluate the impact of individual surgeon's caseload and hospital volume on perioperative outcome.
We retrospectively analyzed 336 consecutive patients undergoing oncological resection for rectal cancer at two Viennese hospitals between 1 January 2015 and 31 December 2020. The effect of baseline characteristics as well as surgeons' caseloads (low volume: 0-5 cases per year, high volume > 5 cases per year) on postoperative complication rates (Clavien-Dindo Classification groups of < 3 and ≥ 3) were evaluated.
No differences in baseline characteristics were found between centers in terms of sex, smoking status, or comorbidities of patients. Interestingly, only 14.7% of surgeons met the criteria to be classified as high-volume surgeons, while accounting for 66.3% of all operations. There was a significant difference in outcomes depending on the treating center in univariate and multivariate binary logistic regression analysis (odds ratio (OR) = 2.403, p = 0.008). Open surgery was associated with lower complication rates than minimally invasive approaches in univariate analysis (OR = 0.417, p = 0.003, 95%CI = 0.232-0.739) but not multivariate analysis. This indicated that the center's policy rather than surgeon volume or mode of surgery impact on postoperative outcomes.
Treating center standards impacted on outcome, while individual caseload of surgeons or mode of surgery did not independently affect complication rates in this analysis. The majority of rectal cancer resections are performed by a small number of surgeons in Viennese hospitals.
在直肠癌手术中，外科医生手术量增加与改善预后之间的明确关系尚未得到令人信服的确立。本研究的目的是评估个体外科医生的病例数和医院手术量对围手术期结局的影响。
我们回顾性分析了2015年1月1日至2020年12月31日期间在维也纳两家医院连续接受直肠癌肿瘤切除手术的336例患者。评估了基线特征以及外科医生的病例数（低手术量：每年0 - 5例，高手术量>每年5例）对术后并发症发生率（Clavien-Dindo分类<3级和≥3级）的影响。
在患者的性别、吸烟状况或合并症方面，各中心之间的基线特征没有差异。有趣的是，只有14.7%的外科医生符合高手术量外科医生的标准，但却完成了所有手术的66.3%。在单因素和多因素二元逻辑回归分析中，根据治疗中心不同，结局存在显著差异（比值比（OR）= 2.403，p = 0.008）。在单因素分析中，开放手术的并发症发生率低于微创方法（OR = 0.417，p = 0.003，95%CI = 0.232 - 0.739），但在多因素分析中并非如此。这表明中心的政策而非外科医生的手术量或手术方式对术后结局有影响。
在本分析中，治疗中心标准影响结局，而外科医生的个体病例数或手术方式并未独立影响并发症发生率。在维也纳医院，大多数直肠癌切除术是由少数外科医生完成的。
