Surgeon Skill Level Tied to Colon Cancer Surgery Survival
Highly skilled surgeons may boost colon cancer survival by 70 percent
THURSDAY, Nov. 5, 2020 (HealthDay News) -- There is an association between surgical technical skill and long-term survival following colon cancer surgery, according to a research letter published online Oct. 30 in JAMA Oncology.
Brian C. Brajcich, M.D., from the American College of Surgeons in Chicago, and colleagues recruited surgeons participating in the 2016 Illinois Surgical Quality Improvement Collaborative for a video-based technical skills assessment, with each surgeon submitting one representative video of a laparoscopic right hemicolectomy. Review was performed by 12 or more surgeons, including two colorectal surgeons with video evaluation experience. The National Cancer Database was used to identify patients who underwent any minimally invasive colectomy for stage I to III epithelial-origin colon cancer; patients with operations performed by participating surgeons were matched by National Provider Identifier numbers.
Based on 609 patients who underwent laparoscopic colectomy at 11 hospitals performed by one of 15 participating surgeons, the researchers found that overall survival differed among skill terciles (five-year survival: 79 percent for the high-skill tercile, 55 percent for the medium-skill tercile, and 60 percent for the low-skill tercile). Survival was improved for the high-skill versus low-skill tercile after adjusting for patient characteristics (hazard ratio [HR], 0.31). There was a higher likelihood of survival with each 0.1-point skill score increment (HR, 0.90). The association between skill and outcomes was strongest among patients with stage II disease (high- versus low-skill tercile: HR, 0.14; medium- versus low-skill tercile: HR, 0.12). Among 307 open procedures, a survival advantage was seen with high-skill surgeons (HR, 0.41) and medium-skill surgeons (HR, 0.41) compared with the low-skill tercile.
"Skill may affect survival through oncologic resection quality (e.g., lymph node harvesting) or may reflect surgeon characteristics, such as operative volume or guideline adherence," the authors write.