Background
Past studies have identified surgeon- and institution- related characteristics as
prognostic factors in colorectal cancer surgery. The present work assesses the influence
of the surgeon’s and the hospital’s caseload on long-term results of colorectal cancer
surgery.
Methods
The data on 2706 patients from 2, randomized, colorectal cancer trials (Swiss Group
for Clinical Cancer Research [SAKK] 40/81, SAKK 40/87) investigating adjuvant intraportal
and systemic chemotherapy and 1 concurrent registration study (SAKK 40/88) were reviewed.
A first analysis included 1809 eligible, nonmetastatic patients from all 3 studies.
A subsequent subgroup analysis included 915 eligible patients from both randomized
trials. Overall survival (OS), disease-free survival (DFS), and local recurrence (LR)
were analyzed in multivariate models taking into account the possible effect of clustering.
The main potential covariates were surgeon’s annual caseload (>5 operations/year vs
≤5 operations/year), hospital’s annual caseload (>26 operations/year vs ≤26 operations/year),
tumor site, T stage, and nodal status.
Results
Primary analysis of all 3 studies combined found a high surgeon’s caseload to be positively
associated with OS (P = .025) and marginally with DFS (P = .058). Separate analysis for each trial, however, showed that a high surgeon’s
caseload was beneficial for outcome in both randomized trials but not in the registration
study. A subgroup analysis of 915 patients with 376 rectal and 539 colonic primaries
from both randomized trials, therefore, was performed. Neither age, gender, year of
operation, adjuvant chemotherapy (intraportal vs systemic vs operation alone), hospital
academic status (university vs nonuniversity), training status of the surgeon (certified
surgeon vs surgeon-in-training), nor inclusion in 1 of the 2 randomized trials (SAKK
40/81 vs SAKK 40/87) was a significant predictor of outcome. However, both high surgeon’s
and high hospital’s annual caseloads were independent, beneficial prognostic factors
for OS (P = .0003, P = .044) and DFS (P = .0008, P = .020), and marginally significant factors for LR (P = .057, P = .055).
Conclusions
High surgeon’s and hospital’s annual caseloads are strong, independent prognostic
factors for extending overall and disease-free survival and reducing the rate of local
recurrence in 2 randomized colorectal cancer trials.
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Article info
Publication history
Accepted:
August 15,
2005
Identification
Copyright
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
