Pattern of colorectal surgery and long-term survival: 10-year experience from a single center

The incidence of colorectal cancer (CRC) has increased in recent decades, and ranks fourth among males and third among females in China. Surgical resection remains the most important treatment modality for curative intent in CRC. Several studies found that surgeon volumes and specialization appeared to be associated with improved overall survival (OS). Moreover, numerous reports have suggested that specialization and minimally invasive surgery have gained increased popularity in CRC surgery. However, few studies have specifically examined the role and long-term survival of all stage CRC in a real-world study.

To evaluate the effect of surgeon specialization on survival changes and minimally invasive surgery utilization in a real world study.

A retrospective analysis on the association between surgeon specialization and OS between 2008 and 2013 in Zhongshan Hospital CRC database was performed. Standard demographic, clinicopathologic, surgical and follow-up data were obtained from the CRC database. Surgeon specialty was categorized as colorectal surgeon (CS) and general surgeon (GS). CRC patients who underwent primary surgical resection were enrolled.

A total of 5141 CRC patients who underwent primary surgical resection between 2008 and 2013 were evaluated, 1748 (34.0%) of these by CS. The percentage of minimally invasive procedures in the CS group showed an increasing trend. There was no benefit associated with surgeon specialization for stage I, II and IV patients. Surgeon specialization exhibited a significant association with OS solely among stage III patients, with 5-year OS rates of 76% and 67% for the CS and GS groups, respectively (P < 0.01). Further analyses found that surgeon specialization was significantly associated with survival only in stage III rectal patients, and the 5-year OS rate in the CS group and GS group was 80% and 67%, respectively (P < 0.01).

Surgeon specialization is associated with improved OS after primary surgery in stage III rectal patients. An appropriate surgical technique, perioperative program and adjuvant therapy may contribute to survival benefit in these patients.