Effect of the surgeon's specialty interest on the type of resection performed for colorectal cancer.

Abstract

The aim of this study was to examine the type of resection performed for colorectal cancer by surgeons with a colorectal interest and compare this with the type of resection performed by surgeons with other specialty interests. One hundred sixteen patients had curative surgery performed for primary colorectal cancer over a one-year period by ten surgeons with four different specialty interests. Surgeons with an interest in colorectal cancer resected twice as much colon (280 mm vs. 130 mm; P > 0.0001, Mann-Whitney U test) and were more likely to remove adjacent clinically involved organs (15 percent vs. 0 percent) for left-sided colon and rectal cancers compared with surgeons with vascular or transplant interests. Surgeons with an interest in gastroenterology performed a resection that was intermediate between the colorectal and other specialty groups for left-sided cancers. Distal resection margins were significantly greater (55 mm vs. 20 mm; P > 0.001) for sigmoid cancers in the colorectal group, but were similar in all groups for rectal cancer. Resection lengths and margins for right-sided cancers were similar in all groups, although the number of lymph nodes retrieved from the mesentery was greater in the colorectal group (13 vs. 7.5; P = 0.08). This study shows a wide variability in the type of resection performed for colorectal cancer and illustrates the need for clinical trials to evaluate the effect of such variability on patient outcome.