Taib A G, Patel Z, Kler A, Maxwell-Armstrong C A
The Royal Blackburn Teaching Hospital, UK.
University Hospital Morecambe Bay NHS Foundation Trust, UK.
Ann R Coll Surg Engl. 2025 Mar;107(3):194-198. doi: 10.1308/rcsann.2024.0059. Epub 2024 Sep 3.
The aim of this study was to explore whether there were any differences in consultant colorectal surgeon training and adjusted 90-day postoperative colorectal cancer mortality rates (AMR).
We undertook a retrospective analysis of outcomes data published on the Association of Coloproctology of Great Britain and Ireland (ACPGBI) website. A total of 51,562 procedures for patients in England diagnosed with large bowel cancer between 2010 and 2015, registered under 551 consultants were included. Consultants were split into two cohorts. The first group were the pre-Calman Trained Consultants (pre-CTr), who completed their training before 1998. The second group-the post-Calman Trained Consultants (post-CTr)-included those who received their Certificate of Completion of Training (CCT) under the Calman Training Principles (CTC, 1998-2007) and the Modernising Medical Careers Curriculum (MMC, 2008 and onwards). The outcome measure was an AMR.
The pre-CTr cohort (=84) consisted of 3.6% female colorectal consultants (=3/84), whereas the post-CTr cohort (=467) consisted of 14.3% female colorectal consultants (=67/467) (=0.006). In this cross-sectional analysis over 5 years, the average pre-CTr undertook a greater number of colorectal resections than their post-CTr peers: median procedures (interquartile range, IQR): 104 (59) vs 89 (57) respectively, =0.008. The median AMR was significantly greater among pre-CTrs compared with post-CTrs, median AMR (IQR): 2.7% (2.0) vs 2.1% (2.9), =0.022.
These data indicate that the implementation of the MMC and Calman training principles for colorectal training is associated with a statistically lower AMR compared with other historical training periods. This merits further exploration.
本研究的目的是探讨结直肠外科顾问医师培训以及调整后的术后90天结直肠癌死亡率（AMR）是否存在差异。
我们对英国和爱尔兰结直肠外科学会（ACPGBI）网站上公布的结局数据进行了回顾性分析。纳入了2010年至2015年间在英格兰被诊断为大肠癌的患者所进行的51562例手术，这些手术由551名顾问医师负责。顾问医师被分为两组。第一组是卡尔曼改革前培训的顾问医师（pre-CTr），他们在1998年之前完成培训。第二组——卡尔曼改革后培训的顾问医师（post-CTr）——包括那些根据卡尔曼培训原则（CTC，1998 - 2007年）以及现代医学职业课程（MMC，2008年及以后）获得培训结业证书（CCT）的医师。结局指标为AMR。
pre-CTr组（n = 84）中有3.6%的女性结直肠顾问医师（n = 3/84），而post-CTr组（n = 467）中有14.3%的女性结直肠顾问医师（n = 67/467）（P = 0.006）。在这项为期5年的横断面分析中，pre-CTr组平均进行的结直肠切除术比post-CTr组的同行更多：手术中位数（四分位间距，IQR）分别为104（59）对89（57），P = 0.008。与post-CTr组相比，pre-CTr组的AMR中位数显著更高，AMR中位数（IQR）：2.7%（2.0）对2.1%（2.9），P = 0.022。
这些数据表明，与其他历史培训时期相比，针对结直肠培训实施MMC和卡尔曼培训原则与统计学上较低的AMR相关。这值得进一步探索。
