Better survival for patients with colon cancer operated on by specialized colorectal surgeons - a nationwide population-based study in Sweden 2007-2010

M Bergvall, S Skullman, K Kodeda, P-A Larsson, M Bergvall, S Skullman, K Kodeda, P-A Larsson

Abstract

Aim: Mortality and complication rates after surgery for colon cancer are high, especially after emergency procedures. The aim of the present study was to evaluate the importance of the formal competence of surgeons for survival and morbidity.

Method: The Swedish Colorectal Cancer Registry prospectively records data on patients diagnosed with cancer within the colon and rectum. A cohort of patients operated on for colon cancer between 2007 and 2010 were followed 5 years after surgery. Data on postoperative morbidity, mortality and long-term survival were compared with regard to formal competency of the most senior surgeon attending the procedure.

Results: This analysis includes 13 365 patients operated on for colon cancer, including 10 434 elective procedures and 2931 emergency cases. The overall 5-year survival was higher for those operated on by subspecialist colorectal surgeons compared with general surgeons (60% vs 48%; P < 0.001). Five-year survival after elective surgery was 63% vs 55% (P < 0.001) and 35% vs 31% (P < 0.05) after emergency procedures when performed by colorectal surgeons compared with general surgeons. Postoperative 30-day mortality was 3% after surgery performed by colorectal surgeons compared with 7% when performed by general surgeons. Mortality at 90 days was 6% after surgery performed by colorectal surgeons compared with 11% for patients operated on by general surgeons (P < 0.001).

Conclusion: Subspecialization in colorectal surgery is associated with better outcome for patients operated on for colon cancer, and effort should be made to increase the availability of colorectal surgeons for both acute and elective colon cancer surgery.

Keywords: Colon cancer; operation; specialty competence; surgery; survival.

Conflict of interest statement

There are no conflicts of interest to declare.

© 2019 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

Figures

Figure 1
Figure 1
Kaplan–Meier curves showing 5‐year survival after surgery performed by colorectal surgeons (green dots) and general surgeons (blue dots). Overall 5‐year survival was 60% when performed by colorectal surgeons compared with 48% after surgery performed by general surgeons (P < 0.001). Corresponding figures after emergency procedures were 36.6% compared with 33.4% (P < 0.05) and 65.5% compared with 59.7% after elective surgery (P < 0.001). Data are missing for 10 emergency procedures and 36 elective operations.

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