Dose surgical sub-specialization influence survival in patients with colorectal cancer?

作     者：Cameron Platell Daniel Lim Nazreen Tajudeen Karen Wong 

作者机构：Department of SurgeryUniversity of Western AustraliaFremantle HospitalAustralia 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2003年第9卷第5期

页      面：961-964页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：I would like to thank Dr Di Rosman at the Health Department of Western Australia for her assistance in linking information with the Deaths Registry of Western Australia 

主　　题：Adult Aged Aged, 80 and over Colorectal Neoplasms Colorectal Surgery Comparative Study Female Hospitals, Community Hospitals, Teaching Humans Male Middle Aged Surgery Survival Rate Treatment Outcome Western Australia 

摘      要：AIM:To perform a review of patients with colorectal cancer to a community hospital and to compare the risk-adjusted survival between patients managed in general surgical units versus a colorectal unit. METHODS:The study evaluated all patients with colorectal cancer referred to either general surgical units or a colorectal unit from 1/1996 to 6/*** results were compared to a historical control group treated within general surgical units at the same hospital from 1/1989 to 12/1994.A Kaplan- Meier survival analysis compared the overall survivals (all- cause mortality) between the groups.A Cox proportional hazards model was used to determine the influence of a number of independent variables on *** variables included age,ASA score,disease stage,emergency surgery, adjuvant chemotherapy and/or radiotherapy,disease location,and surgical unit. RESULTS:There were 974 patients involved in this study. There were no significant differences in the demographic details for thethree *** in the colorectal group were more likely to have rectal cancer and Stage Ⅰ cancers, and less likely to have Stage Ⅱ *** treated in the colorectal group had a significantly higher overall 5-year survival when compared with the general surgical group and the historical control group (56 % versus 45 % and 40 % respectively,P0.01).Survival regression analysis identified age,ASA score,disease stage,adjuvant chemotherapy,and treatment in a colorectal unit (Hazards ratio:0.67;95 % CI:0.53 to 0.84,P =0.0005),as significant independent predictors of survival. CONCLUSION:The results suggest that there may be a survival advantage for patients with colon and rectal cancers being treated within a specialist colorectal surgical unit.