- “That’s pretty amazing”
- Patients treated by highly skilled surgeons are more likely to survive long term
- Ask your surgeon how many similar procedures he has performed
- Colon cancer is one of the most common in the US
CHICAGO – Patients of more tech surgeons after surgery to treat colon cancer have better long-term survival after surgery to treat colon cancer, according to a new study by Northwestern Medicine.
Patients whose surgery was performed by a highly skilled surgeon had a 70 percent lower risk of death over five years compared to patients with a less skilled surgeon.
“That’s pretty mind-boggling,” said lead author Dr. Karl Bilimoria, Professor of Surgery at Northwestern University’s Feinberg School of Medicine and Surgical Oncologist with Northwestern Medicine. “The long-term effect is enormous.”
The paper will be published on October 30th in JAMA oncology and presented virtually at the annual meeting of the Commission on Cancer.
Although the importance of surgical skill has long been suspected, to the authors’ knowledge this is the first study to demonstrate that a surgeon’s skills are important for long-term outcomes in patients undergoing cancer treatment.
“In some ways it might seem reasonable, but we didn’t see the magnitude of the effect,” said Bilimoria. In a previous study the team conducted, there were 25% fewer short-term complications – like a colon leak or bleeding – than a highly skilled surgeon performed the colon cancer surgery.
Colon cancer is one of the most common types of cancer. Over 100,000 new cases are diagnosed annually in the United States. In many cases, surgery is the primary treatment.
Bilimoria is also the director of the Center for Surgical Outcomes and Quality Improvement in the Northwest and a member of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University.
One possible reason for the difference is that a skilled surgeon may be more likely to remove lymph nodes that contain colon cancer, said the study’s lead author, Dr. Brian Brajcich, a northwest-based surgeon and research fellow.
“A less experienced surgeon may not remove as many lymph nodes and may leave cancer behind,” Brajcich said. “Patients who would benefit from chemotherapy after surgery will not receive it if we don’t know that the cancer has spread to the lymph nodes.”
How do you find a highly qualified cancer surgeon?
How do you find a highly qualified cancer surgeon? Ask about the number of similar procedures they’ve performed, Bilimoria said.
“Having a lot of experience with the procedure is a good indicator of skill,” said Bilimoria. “General surgeons, colorectal surgeons, and surgical oncologists all perform colorectal cancer surgeries, and there can be excellent cancer surgeons in each of these areas.”
The study assessed a surgeon’s technical competence by reviewing the video footage of the colon surgery by other surgeons, including colleagues and experts. It then compared the results of patients treated by surgeons with higher and lower skill levels.
Improving the outcomes after surgery, especially cancer surgery, should include efforts aimed at the technical skills of surgeons. Comprehensive approaches to helping surgeons improve their technical skills could include surgical coaching and the opportunity to review and discuss surgical video material with colleagues and experts in the field.
Further research is needed to determine whether efforts to improve surgical skills translate into improved technical skills and patient outcomes. In addition, the actual methods of improving surgical skills need to be further developed and studied to see if they are effective in improving patient outcomes.
Bilimoria acknowledged the small study size but said, “Even in this size study we are seeing a big impact.”
Other northwest writers are Dr. Jonah Stulberg, Jeanette Chung and Reiping Huang.
This study was funded by a grant from the Agency for Research and Quality in Health Care (5R01HS024516), a grant from the National Cancer Institute (T32CA247801) grant from the National Institutes of Health, and a grant from the Health Care Services Corporation.
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