Zhu De-Xiang, Chen Miao, Xu Dong-Hao, He Guo-Dong, Xu Ping-Ping, Lin Qi, Ren Li, Xu Jian-Min
Department of Colorectal Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China.
World J Gastrointest Oncol. 2024 Nov 15;16(11):4383-4391. doi: 10.4251/wjgo.v16.i11.4383.
The incidence of colorectal cancer (CRC) has increased in recent decades, and ranks fourth among males and third among females in China. Surgical resection remains the most important treatment modality for curative intent in CRC. Several studies found that surgeon volumes and specialization appeared to be associated with improved overall survival (OS). Moreover, numerous reports have suggested that specialization and minimally invasive surgery have gained increased popularity in CRC surgery. However, few studies have specifically examined the role and long-term survival of all stage CRC in a real-world study.
To evaluate the effect of surgeon specialization on survival changes and minimally invasive surgery utilization in a real world study.
A retrospective analysis on the association between surgeon specialization and OS between 2008 and 2013 in Zhongshan Hospital CRC database was performed. Standard demographic, clinicopathologic, surgical and follow-up data were obtained from the CRC database. Surgeon specialty was categorized as colorectal surgeon (CS) and general surgeon (GS). CRC patients who underwent primary surgical resection were enrolled.
A total of 5141 CRC patients who underwent primary surgical resection between 2008 and 2013 were evaluated, 1748 (34.0%) of these by CS. The percentage of minimally invasive procedures in the CS group showed an increasing trend. There was no benefit associated with surgeon specialization for stage I, II and IV patients. Surgeon specialization exhibited a significant association with OS solely among stage III patients, with 5-year OS rates of 76% and 67% for the CS and GS groups, respectively ( < 0.01). Further analyses found that surgeon specialization was significantly associated with survival only in stage III rectal patients, and the 5-year OS rate in the CS group and GS group was 80% and 67%, respectively ( < 0.01).
Surgeon specialization is associated with improved OS after primary surgery in stage III rectal patients. An appropriate surgical technique, perioperative program and adjuvant therapy may contribute to survival benefit in these patients.
近几十年来，结直肠癌（CRC）的发病率有所上升，在中国男性中排名第四，女性中排名第三。手术切除仍然是结直肠癌根治性治疗最重要的方式。多项研究发现，外科医生的手术量和专业程度似乎与总体生存率（OS）的提高有关。此外，大量报告表明，专业程度和微创手术在结直肠癌手术中越来越受欢迎。然而，很少有研究在真实世界研究中专门考察所有分期结直肠癌的作用和长期生存情况。
在真实世界研究中评估外科医生专业程度对生存变化和微创手术应用的影响。
对中山医院结直肠癌数据库2008年至2013年期间外科医生专业程度与OS之间的关联进行回顾性分析。从结直肠癌数据库中获取标准的人口统计学、临床病理、手术和随访数据。外科医生专业分为结直肠外科医生（CS）和普通外科医生（GS）。纳入接受初次手术切除的结直肠癌患者。
共评估了2008年至2013年期间接受初次手术切除的5141例结直肠癌患者，其中1748例（34.0%）由CS进行手术。CS组中微创手术的比例呈上升趋势。对于Ⅰ期、Ⅱ期和Ⅳ期患者，外科医生专业程度并无益处。仅在Ⅲ期患者中，外科医生专业程度与OS存在显著关联，CS组和GS组的5年OS率分别为76%和67%（<0.01）。进一步分析发现，外科医生专业程度仅在Ⅲ期直肠癌患者中与生存显著相关，CS组和GS组的5年OS率分别为80%和67%（<0.01）。
外科医生专业程度与Ⅲ期直肠癌患者初次手术后OS的改善有关。合适的手术技术、围手术期方案和辅助治疗可能有助于这些患者获得生存益处。
