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The impact of surgical specialisation on survival following elective colon cancer surgery

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Reorganisation of cancer services in the UK and across Europe has led to elective surgery for colon cancer being increasingly, but not exclusively, delivered by specialist colorectal surgeons. This study examines survival after elective colon cancer surgery performed by specialist compared to non-specialist surgeons.

Method

Patients undergoing elective surgery for colon cancer in 16 hospitals between 2001 and 2004 were identified from a prospectively maintained regional audit database. Post-operative mortality (<30 days) and 5-year relative survival in those receiving surgery under the care of a specialist or non-specialist surgeon were compared.

Results

A total of 1,856 patients were included, of which, 1,367 (73.7 %) were treated by a specialist and 489 (26.4 %) by a non-specialist surgeon. Those treated by a specialist were more likely to be deprived, undergo surgery in a high volume unit and have higher lymph node yields than those treated by a non-specialist. Post-operative mortality was lower (4.5 versus 7.0 %; P = 0.032) and 5-year relative survival was higher (72.2 versus 65.6 %; P = 0.012) among those treated by a specialist surgeon. In multivariate analysis, surgery by non-specialists was independently associated with increased post-operative mortality (adjusted odds ratio (OR) 1.69; P < 0.001) and poorer 5-year relative survival (adjusted relative excess risk (RER) 1.17; P = 0.045). After exclusion of post-operative deaths, there was no difference in long-term survival (adjusted RER 1.08; P = 0.505).

Conclusion

Five-year relative survival after elective colon cancer surgery was higher among those treated by specialist colorectal surgeons due to increased post-operative mortality among those treated by non-specialists.

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Acknowledgments

The authors thank all the surgeons who participated, the West of Scotland Colorectal Cancer Managed Clinical Network advisory board who gave permission for audit data to be used in this study and the London School of Hygiene and Tropical Medicine for providing the life-tables used in the relative survival analysis.

Conflict of interest

All authors declare no conflict of interests.

Funding

No funding received.

Author information

Authors and Affiliations

  1. University Department of Surgery, Faculty of Medicine, University of Glasgow, 4th Floor Walton Building, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK

    Raymond Oliphant, Gary A. Nicholson, Paul G. Horgan & Donald C. McMillan

  2. West of Scotland Cancer Surveillance Unit, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK

    Raymond Oliphant, Gary A. Nicholson & David S. Morrison

  3. West of Scotland Colorectal Cancer Managed Clinical Network, 1st Floor St Mungo Building, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK

    Paul G. Horgan

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  1. Raymond Oliphant
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  2. Gary A. Nicholson
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  3. Paul G. Horgan
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  4. Donald C. McMillan
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  5. David S. Morrison
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in collaboration with the West of Scotland Colorectal Cancer Managed Clinical Network

Corresponding author

Correspondence to Raymond Oliphant.

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Oliphant, R., Nicholson, G.A., Horgan, P.G. et al. The impact of surgical specialisation on survival following elective colon cancer surgery. Int J Colorectal Dis 29, 1143–1150 (2014). https://doi.org/10.1007/s00384-014-1965-0

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  • DOI: https://doi.org/10.1007/s00384-014-1965-0

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