Intended for healthcare professionals

Clinical Review ABC of colorectal cancer

Primary treatment—does the surgeon matter?

BMJ 2000; 321 doi: (Published 04 November 2000) Cite this as: BMJ 2000;321:1121
  1. Colin McArdle

    The dominant factor contributing to the relatively poor prognosis for colorectal cancer is the advanced stage of the disease at the time of initial presentation: up to a third of patients have locally advanced or metastatic disease, which precludes surgical cure. Even in the patients who undergo apparently curative resection, almost half die within five years.

    Colorectal adenoma and tumour—(1);does a patient's survival depend on which surgeon operates?

    In the west of Scotland, for example, about a third of 1842 patients presenting with colorectal cancer to seven hospitals between 1991 and 1994 presented as emergencies. Potentially curative resection was achieved in about 70% of patients presenting electively; the curative resection rate was lower in those presenting as emergencies. Five per cent of patients admitted for elective surgery and 13% of those admitted as emergencies died. Almost 60% of elective patients survived two years, compared with 44% of patients admitted as emergencies. These results are typical of population based studies in the United Kingdom.

    Variation among surgeons

    Most surgeons acknowledge that the incidence of postoperative complications varies widely among individual surgeons. It is now almost 20 years since Fielding and his colleagues in the large bowel cancer project drew attention to differences in anastomotic leak and local recurrence rates after resection for large bowel cancer.

    View this table:

    Variation in outcome, by surgeon, after curative resection (n=338)

    In the original Glasgow Royal Infirmary study, which was conducted in the 1980s, similar differences in postoperative morbidity and mortality were noted. Furthermore, after apparently curative resection, survival at 10 years varied threefold among surgeons.

    View this table:

    Presentation, type of surgery, and postoperative mortality, by hospital and surgeon (n=1842), west of Scotland study. Values are percentages

    One …

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