Should not be a Surprise: Better Surgeons Provide Better Outcomes
Patients who undergo colon surgery by surgeons who routinely perform the surgery generally enjoy longer survival rates than those whose surgeons are less experienced. While the conclusion seems obvious, supporting research offers some go-to points for patients interested in boosting their odds for a successful surgical intervention.
Colorectal cancer is the third most common type of cancer of women and men in the US, with the exception of skin cancers. A study from the Illinois Surgical Quality Improvement Collaborative (ISQIC) discusses a novel study that evaluated the surgical technique of surgeons who performed laparoscopic colectomies on 609 patients. The procedure typically removes a portion of the colon that is cancerous, along with margin tissue, and lymph nodes.
The study was presented as part of an annual meeting of the American College of Surgeons in October 2020. The research followed an earlier study that found patients of highly skilled colorectal surgeons tended to suffer fewer complications such as a bleed or colon leak.
In this research, participating surgeons were videotaped performing a partial surgical removal of the colon. Each video was then reviewed by a minimum of 12 surgeons including two that specialize in reviews of surgical video tapes. Using the American Society of Colon and Rectal Surgeons Video Assessment Tool, each reviewer assigned a score to the participating surgeon.
Among others, the factors considered included:
- Performance of the procedure
- Efficient and methodical technique
- Skill and gentleness of handling and manipulation of tissue
Scores were tabulated to provide an overall score for each surgeon. The results are instructive and include:
- The five most highly rated surgeons also performed the most procedures in the study. This group overall also had the highest average number of surgical cases.
- Surgical volume totals for the top group were twice the number of procedures performed by other surgeons. The five-year survival rate for the group was 79 percent.
- The five-year survival rate for the mid-level group of surgeons was 55 percent.
- For the lowest rated group of surgeons, the five-year patient survival rate was 60 percent.
Lead author and research fellow, Dr. Brian Brajcich notes, “This study demonstrates that surgical technical skill is an important driver of long-term outcomes in cancer surgery. When talking about ways to improve outcomes for patients, we surgeons should not only think about quality measures but ways to improve surgeons’ skills through some form of surgical coaching.”
Researchers suggest patient involvement is important in seeking high quality surgical care for colon cancer and other types of surgery. Suggestions for patients include:
- Speaking with their potential surgeon about the number of procedures of a particular type performed by the surgeon. Inquire on complication rates.
- With any type of surgical intervention, surgeons with a good track record of success and higher volumes of procedures are likely to provide more consistent good outcomes.
- Patients should inquire about how surgeons maintain their skills and stay up to date on their procedural training. In this study, the more skilled surgeons were more likely to remove lymph nodes during surgery, which can help a medical team plan more effective treatment.
While highly skilled surgeons also make errors, research into procedure numbers, current skills, and complication rates can help patients make informed choices that support their hopes for a good surgical outcome.
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