Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2024; 16(11): 4383-4391
Published online Nov 15, 2024. doi: 10.4251/wjgo.v16.i11.4383
Pattern of colorectal surgery and long-term survival: 10-year experience from a single center
De-Xiang Zhu, Miao Chen, Dong-Hao Xu, Guo-Dong He, Ping-Ping Xu, Qi Lin, Li Ren, Jian-Min Xu
De-Xiang Zhu, Miao Chen, Dong-Hao Xu, Guo-Dong He, Ping-Ping Xu, Qi Lin, Li Ren, Jian-Min Xu, Department of Colorectal Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China
Author contributions: Zhu DX, Xu JM conceptualized the study; Ren L, Xu JM provided study material or patients; Zhu DX, Chen M, Xu DH curated the data; Zhu DX, Chen M, Xu DH performed formal analysis; Xu JM acquired funding; Zhu DX, Chen M, Xu DH, Xu PP conducted the investigation; Zhu DX, Chen M, Xu DH developed the methodology; Qi Lin, Ren L, Xu JM administered the project; Zhu DX developed the software and performed visualization; Xu JM supervised and validated the study; Zhu DX, Chen M, Xu JM wrote and revised the manuscript; all authors accessed and verified the study data.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Zhongshan Hospital, Fudan University.
Informed consent statement: All patients in the study provided informed consent.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Min Xu, PhD, Professor, Surgeon, Department of Colorectal Surgery, Zhongshan Hospital Fudan University, No. 180 Fenglin Road, Shanghai 200032, China. xujmin@aliyun.com
Received: February 8, 2024
Revised: April 24, 2024
Accepted: June 17, 2024
Published online: November 15, 2024
Processing time: 259 Days and 20 Hours
Abstract
BACKGROUND

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.

AIM

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

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Colorectal surgery; Minimally invasive surgery; Primary location; Overall survival; Tumor stage; Follow-up

Core Tip: This investigation is the largest real-world study comparing colorectal cancer surgery patterns and overall survival (OS) in a Chinese tertiary university hospital. A total of 5141 colorectal cancer patients who underwent primary surgical resection between 2008 and 2013 were evaluated, 1748 (34.0%) of these by a colorectal surgeon (CS). The percentage of minimally invasive procedures in the CS group showed an increasing trend. We found that 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.