Training outcomes in colorectal cancer surgery in a district general hospital

The purpose of this study was to quantify the effect of training on outcomes following colorectal cancer resections in a District General Hospital.

Data on 102 consecutive elective colorectal cancer resections performed at a District General Hospital over a three-year period were prospectively collated. The proportion of cases performed by trainees was recorded and the seniority of the operating surgeon was related to pre-operative morbidity, operative time and postoperative outcome.

Consultants, staff grades and registrars performed 46, 35 and 21 procedures respectively. Of the cases performed by registrars, consultant supervision was provided in seven cases, with staff grades providing supervision in 14 cases. As compared with consultants, registrars were less likely to undertake anterior resection (p = 0.001). However, the mean operating times of trainees (145 +/- 8 mins) and consultants (135 +/- 6 mins) were similar. There were no significant differences between the groups with respect to postoperative mortality or morbidity. There was a trend towards more advanced disease in consultant cases, and consultants had a significantly poorer freedom from death or recurrence at two years as compared with trainees (p = 0.03).

In our unit, trainees performed 21% of all elective colorectal resections with no detrimental effect on length of hospital stay, overall hospital costs and early and late patient outcomes. Major colorectal procedures can be successfully accomplished in a District General setting by trainees, with the training burden shared between consultants and staff grade surgeons.