Contribution of surgical specialization to improved colorectal cancer survival.

摘要: Background: Reorganization of colorectal cancer services has led to surgery being increasingly, but not exclusively, delivered by specialist surgeons. Outcomes from have improved, the exact determinants remain unclear. This study explored outcome after over time. Methods: Postoperative mortality (within 30 days surgery) and 5-year relative survival rates for patients in West Scotland undergoing between 1991 1994 were compared with those having 2001 2004. Results: The 1823 who had 2001–2004 more likely stage I or III tumours, undergone curative intent than 1715 operated on 1991–1994. proportion presenting electively received a surgeon increased time (from 14· 9t o 72· 8p er cent;P < 0·001). among treated non-specialists 7· 4t 10· 3p = 0·026). Non-specialist was associated an risk postoperative death (adjusted odds ratio 1·72, 95 per cent confidence interval (c.i.) 1·17 2·55; P 0·006) surgery. rate higher non-specialist surgeons (62·1 versus 53· 0p Compared earlier period, adjusted excess later period 0·69 (95 c.i. 0·61 0·79; Increased surgical specialization accounted 18·9 observed improvement. Conclusion: contributed significantly improvement longer-term following