Health

Surgical skills in colectomy associated with long-term survival

The technical skills of surgeons performing colectomy for colon cancer were associated with long-term survival outcomes, the researchers said.

Watching a video of laparoscopic right hemicolectomy submitted by 15 surgeons from 11 hospitals, in this study, surgeons ranked in the top third of skill levels adjusted patient characteristics. Patients were also shown to have the highest overall survival (HR 0.31 vs. at least one-third); 95% CI 0.18-0.54, P<0.001), reported by Karl Y. Bilimoria, MD, MS, and colleagues at the American Academy of Surgeons and Northwestern University in Chicago.

“This association persists even when premature postoperative mortality is excluded, suggesting that these findings are not solely due to mortality from surgical complications,” the researchers said. It was. Written in JAMA Oncology..

Elizabeth Wick, MD, MD, of the University of California, San Francisco, who was not involved in the study, said: Today’s MedPage, “This is an important study that has begun to show that cancer surgery has more subtle nuances than simply removing the tumor-technology is important. In fact, surgery technology affects the long-term survival of our colorectal cancer patients. Give. “

In this study, surgeon skills were reviewed and evaluated by more than 12 surgeons, including two experts in video reviews. Scores were assigned using a video evaluation tool from the American Association of Colon and Rectal Surgeons. Outcomes for participating surgeons were obtained from 609 patients who underwent minimally invasive surgery for stage I-III epithelial-derived colon cancer in the National Cancer Database between 2012 and 2017.

The 5-year overall survival rate was 79% for highly skilled surgeons, 55% for medium-skilled surgeons, and 60% for low-skilled surgeons (60%).P= 0.01). Each 0.1 point increment of skill score was associated with a patient’s increased chance of survival (HR 0.90; 95% CI 0.84-0.97, P= 0.01).

When assessing outcomes by stage of cancer, the association between surgeon skills and outcomes was most pronounced in stage II patients (high and low skill HR 0.14, medium and low skill HR 0.12). .. P<0.001) in both comparisons.

In addition, the survival rate of surgeons considered to be highly skilled was also improved during the 307 open procedure (HR 0.41; 95% CI 0.18-0.90, P= 0.03) and middle skills (HR 0.41; 95% CI 0.23-0.72, P= 0.002) Compared to low skills.

“Skills can affect survival through the quality of tumor resection or reflect surgeon characteristics such as surgical volume and adherence to guidelines,” the researchers write. For example, a high-skilled surgeon examined an average of 23.9 lymph nodes, with 21.2 in the medium-skilled tertile and 20.3. In the low-skilled tertile. However, these differences were not statistically significant.

These results are Results of previous studies by Bilimoria and colleagues This showed wide variation in technical skills among laparoscopic right hemicolectomy surgeons. This study scored a video of a surgeon with a highest quality score of 5. Technical skill scores range from 2.8 to 4.6, with higher scores associated with a combined measure of complication reduction, unplanned reoperation, and mortality or severe morbidity.

If surgeons want to continue to improve patient outcomes, Wick said, “As surgeons, we need to develop practical mechanisms to evaluate and support surgeons’ technical skills during their 30-year career. There is. “

Disclosure

This work was supported by a US Government grant and Healthcare Services Corporation.

Billimoria has not reported any conflicts of interest. The co-authors reported their relationship with NanoString Technologies, Pacira Pharmaceuticals, Intuitive Surgical, and Gentex.

Wick reported research funding from the US Department of Medical Research and Quality.

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