Ebott Jasmine, Has Phinnara, Raker Christina, Robison Katina
Department of Obstetrics and Gynecology, Program in Women's Oncology, Women & Infants Hospital, Providence, Rhode Island.
Department of Obstetrics and Gynecology, Warren-Alpert Medical School of Brown University, Providence, Rhode Island.
JAMA Surg. 2024 Oct 1;159(10):1188-1194. doi: 10.1001/jamasurg.2024.2924.
Extensive bowel surgery is often necessary to achieve complete cytoreduction in patients with epithelial ovarian cancer. Regardless of who performs the surgery, it has been well documented that bowel resections are a high-risk procedure and an anastomotic leak is a severe complication that can occur. There are few studies addressing whether surgeon type impacts surgical outcomes in this patient population.
To compare surgical outcomes between gynecologic oncologist, general surgeons, and a 2-surgeon team approach for patients with advanced epithelial ovarian cancer who underwent bowel surgery during cytoreductive debulking.
DESIGN, SETTING, PARTICIPANTS: This retrospective cohort study used the American College of Surgeons' National Surgical Quality Improvement Program datasets from 2012 through 2020. The aforementioned years of the dataset were analyzed from March 2022 to March 2023 and reanalyzed in May 2024 for quality assurance. Analysis of cytoreductive surgeries performed by a gynecologic oncologist, a general surgeon, or a 2-surgeon team approach for patients with ovarian cancer recorded in National Surgical Quality Improvement Program datasets was included. The 2-surgeon team approach included any combination of the aforementioned surgical specialties.
The primary outcome of interest was anastomotic leak after bowel surgery during ovarian cancer debulking.
A total of 1810 patients were included in the study; in the general surgery cohort, mean (SD) patient age was 65.1 (11.1) years and mean (SD) body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) was 26.9 (7.4); in the gynecologic oncology cohort, mean (SD) patient age was 63.5 (11.7) years and mean BMI (SD) was 27.7 (6.5); and in the 2-surgeon team cohort, mean (SD) patient age 62.4 (12.1) years and mean (SD) BMI was 28.1 (7.0). Gynecologic oncologists performed 1217 cases (67.2%), general surgery performed 97 cases (5.4%), and 496 cases had 2-surgeon teams involved (27.4%). Bivariate analysis revealed an anastomotic leak rate of 3.6% for gynecologic oncologists, 5.2% for general surgeons, and 0.4% for cases that had 2 surgical teams involved (P < .001). By multivariable analysis, the adjusted odds ratio for anastomotic leak was 1.53 (95% CI, 0.59-3.96) for the general surgeon group (P = .38) vs an adjusted odds ratio of 0.11 (95% CI, 0.03-0.47) for the 2-surgeon team approach (P = .003) with the referent being gynecologic oncology.
In this study, the anastomotic leak rate was found to be lower when 2 surgeons participated in the case, regardless of the surgical specialty. These results suggest that team-based care improves surgical outcomes.
对于上皮性卵巢癌患者，广泛的肠道手术通常是实现完全肿瘤细胞减灭所必需的。无论手术由谁进行，肠道切除术都是高风险手术且吻合口漏是可能发生的严重并发症，这已得到充分记录。很少有研究探讨外科医生类型是否会影响该患者群体的手术结果。
比较妇科肿瘤学家、普通外科医生以及双外科医生团队方法对接受肿瘤细胞减灭术中肠道手术的晚期上皮性卵巢癌患者的手术结果。
设计、设置、参与者：这项回顾性队列研究使用了美国外科医师学会2012年至2020年的国家外科质量改进计划数据集。数据集的上述年份在2022年3月至2023年3月进行了分析，并于2024年5月为质量保证进行了重新分析。纳入了对国家外科质量改进计划数据集中记录的由妇科肿瘤学家、普通外科医生或双外科医生团队方法为卵巢癌患者进行的肿瘤细胞减灭术的分析。双外科医生团队方法包括上述手术专科的任何组合。
感兴趣的主要结局是卵巢癌减瘤术中肠道手术后的吻合口漏。
该研究共纳入1810例患者；在普通外科队列中，患者平均（标准差）年龄为65.1（11.1）岁，平均（标准差）体重指数（BMI）（计算方法为体重千克数除以身高米数的平方）为26.9（7.4）；在妇科肿瘤学队列中，患者平均（标准差）年龄为63.5（11.7）岁，平均BMI（标准差）为27.7（6.5）；在双外科医生团队队列中，患者平均（标准差）年龄为62.4（12.1）岁，平均（标准差）BMI为28.1（7.0）。妇科肿瘤学家进行了其中1217例（67.2%），普通外科进行了97例（5.4%），496例有双外科医生团队参与（27.4%）。双变量分析显示，妇科肿瘤学家的吻合口漏率为3.6%，普通外科医生为5.2%，有两个手术团队参与的病例为0.4%（P＜0.001）。通过多变量分析，普通外科医生组吻合口漏的调整优势比为1.53（95%置信区间，0.59 - 3.96）（P = 0.38），而双外科医生团队方法的调整优势比为0.11（95%置信区间，0.03 - 0.47）（P = 0.003），以妇科肿瘤学为参照。
在本研究中，发现当有两名外科医生参与病例时，无论手术专科如何，吻合口漏率较低。这些结果表明基于团队的护理可改善手术结果。
