Study on the Effect of Surgeon Specialization upon the Result of Radical Resection for Rectal Carcinoma_West China Medical Journal

Authors：

LUO Yi , LIU Chang , GAN Zhiming , JIA Liuqun , WANG Xiaodong ,  LI Li.

Surgery Center of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LI Li., Email: 851733278@qq.com

Keywords：

專業化; 直腸癌; 手術質量; 并發癥

DOI：

10.7507/1002-0179.20130315

Video：

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目的　探討醫生的專業化程度對直腸癌根治性切除術質量的影響。方法　納入2007年7月－2009年12月收治且確診為直腸癌的手術患者共679例，分為專業組（470例）和非專業組（209例），收集患者年齡、體質量指數（BMI）、腫瘤TNM分期、手術持續時間、術中出血量、術后胃腸功能恢復時間、術后并發癥等圍手術期指標，進行相關統計學分析。結果　兩組患者手術持續時間相當（P=0.322），但在專業組中患者術中出血量較非專業組少（P=0.008）。專業組患者術后拔除胃管時間（P=0.000）、拔除引流管時間（P=0.000）、首次進流質食物時間（P=0.002）、首次排便時間（P=0.007）和下床活動時間（P=0.001）均較非專業組提前，術后住院時間（P=0.152）與住院總時間（P=0.983）兩組差異無統計學意義，且專業組術后并發癥總發生率較低（P＜0.05）。結論　醫生的專業化程度對直腸癌根治術患者圍手術期的管理有顯著影響，專業化程度高的直腸癌外科醫生可為患者帶來更好的手術效果。

Citation： LUO Yi,LIU Chang,GAN Zhiming,JIA Liuqun,WANG Xiaodong,LI Li.. Study on the Effect of Surgeon Specialization upon the Result of Radical Resection for Rectal Carcinoma. West China Medical Journal, 2013, 28(7): 1017-1020. doi: 10.7507/1002-0179.20130315 Copy

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2.	曹向陽. 調整組織結構促進醫院發展[J]. 中醫藥管理雜志, 2009, 17(1): 58-61.
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4.	李立, 汪曉東, 舒曄, 等. 四川大學華西醫院結直腸癌手術治療指南(三)[J]. 中國普外基礎與臨床雜志, 2008, 15(12): 941-942.
5.	Nagtegaal ID, van Krieken JH. The role of pathologists in the quality control of diagnosis and treatment of rectal cancer-an overview[J]. Eur J Cancer, 2002, 38(7): 964-972.
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9.	Begg CB, Cramer LD, Hoskins WJ, et al. Impact of hospital volume on operative mortality for major cancer surgery[J]. JAMA, 1998, 280(20): 1747-1751.
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11.	Schrag D, Cramer LD, Bach PB, et al. Influence of hospital procedure volume on outcomes following surgery for colon cancer[J]. JAMA, 2000, 284(23): 3028-3035.
12.	Harmon JW, Tang DG, Gordon TA, et al. Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection[J]. Ann Surg, 1999, 230(3): 404-411.
13.	Martínez-Ramos M, Escrig-Sos J, Miralles-Tena JM, et al. Influence of surgeon specialization upon the results of colon cancer surgery. Usefulness of propensity scores[J]. Rev Esp Enferm Dig (Madrid), 2008, 100(7): 387-392.
14.	Mella J, Biffin A, Radcliffe AG, et al. Population-based audit of colorectal cancer management in two UK health regions[J]. Br J Surg, 1997, 84(1): 1731-1736.
15.	Chern H, Chou J, Donkor C, et al. Effects of obesity in rectal cancer surgery[J]. J Am Coll Surg, 2010, 211(1): 55-60.
16.	Karahasanoglu T, Hamzaoglu I, Baca B, et al. Impact of increased body mass index on laparoscopic surgery for rectal cancer[J]. Eur Surg Res, 2011, 46(2): 87-93.
17.	Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations[J]. Br J Surg, 2005, 92(6): 673-680.
18.	Repin VN, Tkachenko IM, Gudkov OS, et al. Enteral tube feeding early after surgery on the stomach and the duodenum[J]. Khirurgiia (Mosk), 2002(12): 21-25.
19.	Kaur N, Gupta MK, Minocha VR. Early enteral feeding by nasoenteric tubes in patients with perforation peritonitis[J]. World J Surg, 2005, 29(8): 1023-1027.
20.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78(5): 606-617.
21.	Delaney CP, Zutshi M, Senagore AJ, et al. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection[J]. Dis Colon Rectum, 2003, 46(7): 851-859.

1. 　周巖冰, 江海濤, 周曉斌, 等. 直腸癌手術的質量控制[J]. 青島大學醫學院學報, 2006, 42(2): 95-98.
2. 　曹向陽. 調整組織結構促進醫院發展[J]. 中醫藥管理雜志, 2009, 17(1): 58-61.
3. 　呂東昊, 汪曉東, 陽川華, 等. 結直腸腫瘤多學科協作診治模式的數據庫初期建設現狀[J]. 中國普外基礎與臨床雜志, 2007, 14(6): 713-715.
4. 　李立, 汪曉東, 舒曄, 等. 四川大學華西醫院結直腸癌手術治療指南(三)[J]. 中國普外基礎與臨床雜志, 2008, 15(12): 941-942.
5. 　Nagtegaal ID, van Krieken JH. The role of pathologists in the quality control of diagnosis and treatment of rectal cancer-an overview[J]. Eur J Cancer, 2002, 38(7): 964-972.
6. 　Ferenschild FT, Dawson I, de Wilt JH, et al. Total mesorectal excision for rectal cancer in an unselected population: quality assessment in a low volume center[J]. Int J Colorectal Dis, 2009, 24(8): 923-929.
7. 　Dent OF, Haboubi N, Chapuis PH, et al. Assessing the evidence for an association between circumferential tumour clearance and local recurrence after resection of rectal cancer[J]. Colorectal Dis, 2007, 9(2): 112-121.
8. 　Andreoni B, Chiappa A, Bertani E, et al. Surgical outcomes for colon and rectal cancer over a decade: results from a consecutive monocentric experience in 902 unselected patients[J]. World J Surg Oncol, 2007, 5(73): 73.
9. 　Begg CB, Cramer LD, Hoskins WJ, et al. Impact of hospital volume on operative mortality for major cancer surgery[J]. JAMA, 1998, 280(20): 1747-1751.
10. 　Garcia-Granero G, E. Impact of surgeon organization and specialization in rectal cancer outcome[J]. Colorectal Dis, 2001, 3(3): 179-184.
11. 　Schrag D, Cramer LD, Bach PB, et al. Influence of hospital procedure volume on outcomes following surgery for colon cancer[J]. JAMA, 2000, 284(23): 3028-3035.
12. 　Harmon JW, Tang DG, Gordon TA, et al. Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection[J]. Ann Surg, 1999, 230(3): 404-411.
13. 　Martínez-Ramos M, Escrig-Sos J, Miralles-Tena JM, et al. Influence of surgeon specialization upon the results of colon cancer surgery. Usefulness of propensity scores[J]. Rev Esp Enferm Dig (Madrid), 2008, 100(7): 387-392.
14. 　Mella J, Biffin A, Radcliffe AG, et al. Population-based audit of colorectal cancer management in two UK health regions[J]. Br J Surg, 1997, 84(1): 1731-1736.
15. 　Chern H, Chou J, Donkor C, et al. Effects of obesity in rectal cancer surgery[J]. J Am Coll Surg, 2010, 211(1): 55-60.
16. 　Karahasanoglu T, Hamzaoglu I, Baca B, et al. Impact of increased body mass index on laparoscopic surgery for rectal cancer[J]. Eur Surg Res, 2011, 46(2): 87-93.
17. 　Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations[J]. Br J Surg, 2005, 92(6): 673-680.
18. 　Repin VN, Tkachenko IM, Gudkov OS, et al. Enteral tube feeding early after surgery on the stomach and the duodenum[J]. Khirurgiia (Mosk), 2002(12): 21-25.
19. 　Kaur N, Gupta MK, Minocha VR. Early enteral feeding by nasoenteric tubes in patients with perforation peritonitis[J]. World J Surg, 2005, 29(8): 1023-1027.
20. 　Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78(5): 606-617.
21. 　Delaney CP, Zutshi M, Senagore AJ, et al. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection[J]. Dis Colon Rectum, 2003, 46(7): 851-859.

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Study on the Effect of Surgeon Specialization upon the Result of Radical Resection for Rectal Carcinoma

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