Case Volume

Porter et al. compared the results of colorectal-trained and general surgeons as well as high-volume and low-volume surgeons in regards to abdom inoperineal resection (APR) and LAR [29]. The study reviewed 683 resections carried out by a total of 52 surgeons over a 7-year period. Low-volume surgeons (less than 3 cases per year) accounted for 47% of the cases, whereas high-volume surgeons (greater than or equal to 3 cases per year) did the rest of the cases. In 34% a colorectal specialist took care of the patients; the rest was done by general surgeons. Regarding the operations performed, the percentage of APRs for the specialists was 28% whereas it was 47% for the general surgeons; LAR was carried out by the colorectal surgeons in 73% and in 35% of the cases done by the general surgeons. Analysis of the long-term results suggests that both specialty training and volume of cases had an impact on the local recurrence and survival rates. The local recurrence rates for each subgroup of surgeons are as follows: high-volume colorectal surgeon, 10.4%; low-volume colorectal surgeon, 21.1%; high-volume general surgeon, 27.8%; and low-volume general surgeon, 44.6%. The corresponding survival rates are as follows: high-volume colorectal surgeon, 67.3%; low-volume colorectal surgeon, 54.5%; high-volume general surgeon, 49%; and low-volume general surgeon, 39%.

Read et al. retrospectively compared the results of colorectal surgeons and general surgeons that carried out proctectomy on a population of 384 rectal cancer patients that all underwent neoadjuvant radiotherapy [30]. The colorectal surgeons did 65% of the cases, the general surgeons 35%. The disease-free survival was 77% for the specialists and 68% for the general surgeons (p<0.05). The local recurrence rates were 7% for the colorectal surgeons and 16% for the gen-eralists (p<0.05). The rate of LAR was also significantly higher in patients operated on by the colorec-tal surgeons (52 vs. 30%).

Martling et al. reviewed the Swedish rectal cancer resection results after a series of surgical TME workshops that were held in Stockholm in the 1990s by Bill Heald [11]. Over a 2-year period (1995-1997), 652 rectal cancer patients were operated on. High volume surgeons (13 or more resections per year) did 48% of the cases. The local recurrence rates were significantly lower for the high-volume surgeons (4%) than for the low-volume group (10%, p=0.02); the same was true for the survival rates (89 vs. 82%, p=0.007).

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