Is the Surgeon's Experience an Independent Prognostic Factor in Rectal Cancer?
The aim of the study was to evaluate the influence of the surgeons' caseload on the results of therapy in rectal cancer.
Material and methods. 286 consecutive patients (155 males and 131 females) were enrolled and operated on for rectal cancer stage T2 (112 patients) and T3 (174 patients) in 8 surgical centers of Szczecin between January 1993 and December 1997. Studied group included about 79% of radically operated patients due were to rectal cancer in analyzed period.
Results. The patients were assigned to one of two groups with regard to the surgeon's caseload. The first group was comprised of 116 patients (including 72 stage T3 and 54 stage T2 patients) operated on by surgeons more experienced in rectal surgery and the second group was comprised of 160 patients operated on by 36 surgeons with fewer caseloads. The surgeon's experience in rectal surgery was measured by the surgeon's caseload throughout the entire study period. We considered surgeons with greater than 25 cases over the study period experienced.
Analysis of survival with regard to the managing center revealed significant differences for stage T3, with 5-year-survival rates ranging from 14% to 60%. Distinct differences were also noted for survival rates in stage T2 (5-year-survival rates ranged from 38% to 86%); however, these differences were not statistically significant. Analysis of the influence of surgeon's caseload on outcomes in rectal cancer revealed a significant influence in stage T3 and a lack of influence in stage T2.
Conclusion. The surgeon's experience is an independent prognostic factor for stage T3 rectal cancer patients.