专业化和手术负荷对结直肠癌手术质量的影响_West China Medical Journal

Authors：

胡雪姣 ^1,2 , 马琛 ¹ , 罗翼 ² , 汪晓东 ^1,2 ,  李立 ¹

Corresponding author：

李立, Email: 804876291@qq.com

Keywords：

专业化; 手术负荷; 手术容量; 结直肠癌; 手术质量

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【摘要】　目前国内外学者常通过医生专业化程度、医生手术负荷量以及医院手术容量3个较为主观的指标来评价医生与医院因素对结直肠癌患者手术效果和生存预后的影响程度。这从医生和医院的角度为结直肠癌手术质量评估体系增添了新的内容，对医学生和年轻医生的培养提供了专业技能训练的指导。现就医生的专业化程度和负荷量、医院手术容量在结直肠癌手术中所起作用的研究近况进行综述。

Citation： 胡雪姣,马琛,罗翼,汪晓东,李立. 专业化和手术负荷对结直肠癌手术质量的影响. West China Medical Journal, 2011, 26(8): 1259-1263. doi: Copy

1.	Basili G, Lorenzetti L, Biondi G, et al. Colorectal cancer in the elderly.Is there a role for safe and curative surgery?[J]. Roy Australas Colle Surg, 2008, 78(6): 466-470.
2.	Kim JC, Kim HC, Yu CS, et al. Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging[J]. Am J Surg, 2006, 192(1): 89-97.
3.	Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging[J]. Radiol Clin North Am, 2007, 45(1): 85-118.
4.	李立, 汪晓东, 舒晔, 等. 四川大学华西医院?结直肠癌手术治疗指南(一)[J]. 中国普外基础与临床杂志, 2008, 15(10): 778.
5.	汪晓东, 曹霖, 吕东昊, 等. 多学科协作诊治模式下结直肠癌新辅助化疗联合手术的风险评估研究[J]. 中国普外基础与临床杂志, 2008, 15(9): 692-696.
6.	Andrén-Sandberg A, Neoptoloemos JP. Resection for pancreatic cancer in the new millennium[J]. Pancreatology, 2002, 2(5): 431-439.
7.	Bachmann MO, Alderson D, Edwards D, et al. Cohort study in South and West England of the influence of specialization on the management and outcome of patients with oesophageal and gastric cancers[J]. Br J Surg, 2002, 89(7): 914-922.
8.	Gillison EW, Powell J, McConkey CC, et al. Surgical workload and outcome after resection for carcinoma of the oesophagus and cardia[J]. Br J Surg, 2002, 89(3): 344-348.
9.	Chowdhury MM, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome[J]. Br J Surg, 2007; 94(2): 145-161.
10.	Golledge J, Wiggins JE, Callam MJ. Effect of surgical subspecialization on breast cancer outcome[J]. Br J Surg, 2000, 87(10): 1420-1425.
11.	Anwar S, Fraser S, Hill J. Surgical specialization and training-its relation to clinical outcome for colorectal cancer surgery[J]. J Eval Clin Pract, 2010, 17(3): 1365-2753.
12.	Smith JAE, King PM, Lane RHS, et al. Evidence of the effect of “specialization”on the management, surgical outcome and survival from colorectal cancer in Wessex[J]. Br J Surg, 2003, 90(5): 583-592.
13.	Hall BL, Hsiao EY, Majercik S, et al. The impact of surgeon specialization on patient mortality examination of a continuous herfindahl-hirschman index[J]. Ann Surg, 2009, 249(5): 708-716.
14.	Platell C, Lim D, Tajudeen N, et al. Dose surgical sub-specialization influence survival in patients with colorectal cancer?[J]. World J Gastroenterol, 2003, 9(5): 961-964.
15.	García-Granero E, Martí-Obiol R, Gómez-Barbadillo J, et al. Impact of surgeon organization and specialization in rectal cancer outcome[J]. Colorectal Dis, 2001, 3(3): 179-184.
16.	McArdle CS, Hole DJ. Influence of volume and specialization on survival following surgery for colorectal cancer[J]. Br J Surg, 2004, 91(5):610-617.
17.	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): 404-413.
18.	周岩冰, 江海涛, 周晓斌, 等. 直肠癌手术的质量控制[J]. 青岛大学医学院学报, 2006, 42(2): 95-98.
19.	Martínez-Ramos D, 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, 2008, 100(7): 387-392.
20.	Brnnström F, Jestin P, Matthiesen P, et al. Surgeon and hospital-related risk factors in colorectal cancer surgery[J]. Colorec Dis, 2010, 13(7): 1318-1463.
21.	Heldenberg E, Vishne TH, Onaka N, et al. Rectal cancer: the impact of a colorectal unit on the preservation of the anal sphincter[J]. IMAJ, 2004, 6(8): 471-473.
22.	Borowski DW, Kelly SB, Bradburn DM, et al. Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery[J]. Br J Surg, 2007, 94(7): 880-889.
23.	Garner JP, Prytherch D, Senapati A,et al. Sub-specialization in general surgery: the problem of providing a safe emergency general surgical service[J]. Colorec Dis, 2006, 8(4): 273-277.
24.	Luján J, Hernández Q, Valero G, et al. Influencia del factor cirujano en el tratamiento quirúrgico del cáncer de recto con quimiorradioterapia preoperatoria. Estudio comparativo[J]. Cir Esp, 2006, 79(2): 89-94.
25.	Schrag D, Panageas KS, Riedel E, et al. Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection[J]. J Surg Oncol, 2003, 83(2): 68-79.
26.	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.
27.	Holm T, Johansson H, Cedermark B, et al. Influence of hospital-and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy[J]. Br J Surg, 1997, 84(5): 657-663.
28.	Hannan EL, O’Donnell JF, Kilburn H, et al. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals[J]. JAMA, 1989, 262(4): 503-510.
29.	Chuah TK, Lee T, Wirtzfeld D, et al. Management of primary rectal cancer by surgeons in Atlantic Canada: results of a regional survey[J]. Can J Surg, 2010, 53(6): 396-402.
30.	Lee S, Park Y, Sohn S. A Survey on the Impact of Operation Volume on Rectal Cancer Management[J]. J Korean Med Sci, 2007, 22(Suppl 1): 86-90.
31.	Studer, Peter, Inderbitzin, et al. Surgery-related risk factors[J]. Cur Opin Crit Care, 2009, 15(4): 328-332.
32.	Halm EA, Lee C, Chassin MR, et al. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature[J]. Ann Intern Med, 2002, 137(6): 511-520.
33.	Porter GA, Soskolne CL, Yakimets WW, et al. Surgeon-related factors and outcome in rectal cancer[J]. Ann Surg, 1998, 227(2): 157-167.
34.	Iversen LH, Harling H, Laurberg S, et al. Influence of caseload and surgical speciality on outcome[J]. Colorec Dis, 2006, 9(1): 28-37.
35.	Morris E, Forman D, Haward B. The impact of the Calman-Hine report: analysis of breast and colorectal cancer surgical workloads and the degree of surgical site specialization in the Yorkshire region of the UK, 1990-2000[J]. Eur J Cancer Care, 2007, 16(2):150-155.
36.	Nugent E, Neary P. Rectal cancer surgery: volume-outcome analysis[J]. Int J Colorectal Dis, 2010, 25(12): 1389-1396.
37.	Drolet S, MacLean AR, Myers RP, et al. Elective resection of colon cancer by high-volume surgeons is associated with decreased morbidity and mortality[J]. J Gastro Surg, 2010, 15(4): 541-550.
38.	Purves H, Pietrobon R, Hervey S, et al. Relationship between surgeon caseload and sphincter preservation in patients with rectal cancer[J]. Dis Colon Rectum, 2005, 48(2):195-204.
39.	Mcgrath DR, Leong DC, Gibberd R, et al. surgeon and hospital volume and the management of color ectal cancer patients in Australia[J]. Surg, 2005, 75(10): 901-910.
40.	Weitz J, Koch M, Friess H, et al. Impact of Volume and Specialization for Cancer Surgery[J]. Dig Surg, 2004, 21(4): 253-261.
41.	Hodgson DC, Zhang W, Zaslavsky AM, et al. Relation of hospital volume to colostomy rates and survival for patients with rectal cancer[J]. J Nat Cancer Inst, 2003, 95(10): 708-716.
42.	Borowski DW, Bradburn DM, Mills SJ, et al. Volume-outcome analysis of colorectal cancer-related outcomes[J]. Br J Surg, 2010, 97(9): 1416-1430.
43.	Simunovic M, Rempel E, Thériault ME, et al. Influence of hospital characteristics on operative death and survival of patients after major cancer surgery in Ontario[J]. Can J Surg, 2006, 49(4): 251-258.
44.	Marusch F, Koch A, Schmidt U, et al. Hospital caseload and the results achieved in patients with rectal cancer[J]. Br J Surg, 2001, 88(10): 1397-1402.
45.	Elferink MA, Krijnen P, Wouters MW, et al. Variation in treatment and outcome of patients with rectal cancer by region, hospital type and volume in the Netherlands[J]. EJSO, 2010, 36(Suppl 1): 1-9.
46.	Rogers SO, Wolf RE, Zaslavsky AM, et al. Relation of surgeon and hospital volume to processes and outcomes of colorectal cancer surgery[J]. Ann Surg, 2006, 244(6): 1003-1011.
47.	Billingsley KG, Morris AM, Dominitz JA, et al. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery[J]. Arch Surg, 2007, 142(1): 23-31.
48.	Birkmeyer JD, Stukel TA, Siewers AE,et al. Surgeon volume and operative mortality in the United States[J]. N Engl J Med,2003, 349(22): 2117-2127.
49.	Schrag D, Panageas KS, Riedel E, et al. Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection[J]. Ann Surg, 2002, 236(5): 583-592.
50.	Hannan EL, Radzyner M, Rubin D, et al. The influence of hospital and surgeon volume on in-patient mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer[J]. Surgery, 2002, 131(1): 6-15.
51.	Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care[J]. J Clin Oncol, 2000, 18(11): 2327-2340.
52.	Killeen SD, O’Sullivan MJ, Coffey JC, et al. Provider volume and outcomes for oncological procedures[J]. Br J Surg, 2005, 92(4): 389-402.
53.	van Gijn W. Volume and outcome in colorectal cancer surgery[J]. Eur J Surg Oncol, 2010,36(Suppl 1): 55-63.

1. 　Basili G, Lorenzetti L, Biondi G, et al. Colorectal cancer in the elderly.Is there a role for safe and curative surgery?[J]. Roy Australas Colle Surg, 2008, 78(6): 466-470.
2. 　Kim JC, Kim HC, Yu CS, et al. Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging[J]. Am J Surg, 2006, 192(1): 89-97.
3. 　Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging[J]. Radiol Clin North Am, 2007, 45(1): 85-118.
4. 　李立, 汪晓东, 舒晔, 等. 四川大学华西医院?结直肠癌手术治疗指南(一)[J]. 中国普外基础与临床杂志, 2008, 15(10): 778.
5. 　汪晓东, 曹霖, 吕东昊, 等. 多学科协作诊治模式下结直肠癌新辅助化疗联合手术的风险评估研究[J]. 中国普外基础与临床杂志, 2008, 15(9): 692-696.
6. 　Andrén-Sandberg A, Neoptoloemos JP. Resection for pancreatic cancer in the new millennium[J]. Pancreatology, 2002, 2(5): 431-439.
7. 　Bachmann MO, Alderson D, Edwards D, et al. Cohort study in South and West England of the influence of specialization on the management and outcome of patients with oesophageal and gastric cancers[J]. Br J Surg, 2002, 89(7): 914-922.
8. 　Gillison EW, Powell J, McConkey CC, et al. Surgical workload and outcome after resection for carcinoma of the oesophagus and cardia[J]. Br J Surg, 2002, 89(3): 344-348.
9. 　Chowdhury MM, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome[J]. Br J Surg, 2007; 94(2): 145-161.
10. 　Golledge J, Wiggins JE, Callam MJ. Effect of surgical subspecialization on breast cancer outcome[J]. Br J Surg, 2000, 87(10): 1420-1425.
11. 　Anwar S, Fraser S, Hill J. Surgical specialization and training-its relation to clinical outcome for colorectal cancer surgery[J]. J Eval Clin Pract, 2010, 17(3): 1365-2753.
12. 　Smith JAE, King PM, Lane RHS, et al. Evidence of the effect of “specialization”on the management, surgical outcome and survival from colorectal cancer in Wessex[J]. Br J Surg, 2003, 90(5): 583-592.
13. 　Hall BL, Hsiao EY, Majercik S, et al. The impact of surgeon specialization on patient mortality examination of a continuous herfindahl-hirschman index[J]. Ann Surg, 2009, 249(5): 708-716.
14. 　Platell C, Lim D, Tajudeen N, et al. Dose surgical sub-specialization influence survival in patients with colorectal cancer?[J]. World J Gastroenterol, 2003, 9(5): 961-964.
15. 　García-Granero E, Martí-Obiol R, Gómez-Barbadillo J, et al. Impact of surgeon organization and specialization in rectal cancer outcome[J]. Colorectal Dis, 2001, 3(3): 179-184.
16. 　McArdle CS, Hole DJ. Influence of volume and specialization on survival following surgery for colorectal cancer[J]. Br J Surg, 2004, 91(5):610-617.
17. 　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): 404-413.
18. 　周岩冰, 江海涛, 周晓斌, 等. 直肠癌手术的质量控制[J]. 青岛大学医学院学报, 2006, 42(2): 95-98.
19. 　Martínez-Ramos D, 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, 2008, 100(7): 387-392.
20. 　Brnnström F, Jestin P, Matthiesen P, et al. Surgeon and hospital-related risk factors in colorectal cancer surgery[J]. Colorec Dis, 2010, 13(7): 1318-1463.
21. 　Heldenberg E, Vishne TH, Onaka N, et al. Rectal cancer: the impact of a colorectal unit on the preservation of the anal sphincter[J]. IMAJ, 2004, 6(8): 471-473.
22. 　Borowski DW, Kelly SB, Bradburn DM, et al. Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery[J]. Br J Surg, 2007, 94(7): 880-889.
23. 　Garner JP, Prytherch D, Senapati A,et al. Sub-specialization in general surgery: the problem of providing a safe emergency general surgical service[J]. Colorec Dis, 2006, 8(4): 273-277.
24. 　Luján J, Hernández Q, Valero G, et al. Influencia del factor cirujano en el tratamiento quirúrgico del cáncer de recto con quimiorradioterapia preoperatoria. Estudio comparativo[J]. Cir Esp, 2006, 79(2): 89-94.
25. 　Schrag D, Panageas KS, Riedel E, et al. Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection[J]. J Surg Oncol, 2003, 83(2): 68-79.
26. 　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.
27. 　Holm T, Johansson H, Cedermark B, et al. Influence of hospital-and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy[J]. Br J Surg, 1997, 84(5): 657-663.
28. 　Hannan EL, O’Donnell JF, Kilburn H, et al. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals[J]. JAMA, 1989, 262(4): 503-510.
29. 　Chuah TK, Lee T, Wirtzfeld D, et al. Management of primary rectal cancer by surgeons in Atlantic Canada: results of a regional survey[J]. Can J Surg, 2010, 53(6): 396-402.
30. 　Lee S, Park Y, Sohn S. A Survey on the Impact of Operation Volume on Rectal Cancer Management[J]. J Korean Med Sci, 2007, 22(Suppl 1): 86-90.
31. 　Studer, Peter, Inderbitzin, et al. Surgery-related risk factors[J]. Cur Opin Crit Care, 2009, 15(4): 328-332.
32. 　Halm EA, Lee C, Chassin MR, et al. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature[J]. Ann Intern Med, 2002, 137(6): 511-520.
33. 　Porter GA, Soskolne CL, Yakimets WW, et al. Surgeon-related factors and outcome in rectal cancer[J]. Ann Surg, 1998, 227(2): 157-167.
34. 　Iversen LH, Harling H, Laurberg S, et al. Influence of caseload and surgical speciality on outcome[J]. Colorec Dis, 2006, 9(1): 28-37.
35. 　Morris E, Forman D, Haward B. The impact of the Calman-Hine report: analysis of breast and colorectal cancer surgical workloads and the degree of surgical site specialization in the Yorkshire region of the UK, 1990-2000[J]. Eur J Cancer Care, 2007, 16(2):150-155.
36. 　Nugent E, Neary P. Rectal cancer surgery: volume-outcome analysis[J]. Int J Colorectal Dis, 2010, 25(12): 1389-1396.
37. 　Drolet S, MacLean AR, Myers RP, et al. Elective resection of colon cancer by high-volume surgeons is associated with decreased morbidity and mortality[J]. J Gastro Surg, 2010, 15(4): 541-550.
38. 　Purves H, Pietrobon R, Hervey S, et al. Relationship between surgeon caseload and sphincter preservation in patients with rectal cancer[J]. Dis Colon Rectum, 2005, 48(2):195-204.
39. 　Mcgrath DR, Leong DC, Gibberd R, et al. surgeon and hospital volume and the management of color ectal cancer patients in Australia[J]. Surg, 2005, 75(10): 901-910.
40. 　Weitz J, Koch M, Friess H, et al. Impact of Volume and Specialization for Cancer Surgery[J]. Dig Surg, 2004, 21(4): 253-261.
41. 　Hodgson DC, Zhang W, Zaslavsky AM, et al. Relation of hospital volume to colostomy rates and survival for patients with rectal cancer[J]. J Nat Cancer Inst, 2003, 95(10): 708-716.
42. 　Borowski DW, Bradburn DM, Mills SJ, et al. Volume-outcome analysis of colorectal cancer-related outcomes[J]. Br J Surg, 2010, 97(9): 1416-1430.
43. 　Simunovic M, Rempel E, Thériault ME, et al. Influence of hospital characteristics on operative death and survival of patients after major cancer surgery in Ontario[J]. Can J Surg, 2006, 49(4): 251-258.
44. 　Marusch F, Koch A, Schmidt U, et al. Hospital caseload and the results achieved in patients with rectal cancer[J]. Br J Surg, 2001, 88(10): 1397-1402.
45. 　Elferink MA, Krijnen P, Wouters MW, et al. Variation in treatment and outcome of patients with rectal cancer by region, hospital type and volume in the Netherlands[J]. EJSO, 2010, 36(Suppl 1): 1-9.
46. 　Rogers SO, Wolf RE, Zaslavsky AM, et al. Relation of surgeon and hospital volume to processes and outcomes of colorectal cancer surgery[J]. Ann Surg, 2006, 244(6): 1003-1011.
47. 　Billingsley KG, Morris AM, Dominitz JA, et al. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery[J]. Arch Surg, 2007, 142(1): 23-31.
48. 　Birkmeyer JD, Stukel TA, Siewers AE,et al. Surgeon volume and operative mortality in the United States[J]. N Engl J Med,2003, 349(22): 2117-2127.
49. 　Schrag D, Panageas KS, Riedel E, et al. Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection[J]. Ann Surg, 2002, 236(5): 583-592.
50. 　Hannan EL, Radzyner M, Rubin D, et al. The influence of hospital and surgeon volume on in-patient mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer[J]. Surgery, 2002, 131(1): 6-15.
51. 　Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care[J]. J Clin Oncol, 2000, 18(11): 2327-2340.
52. 　Killeen SD, O’Sullivan MJ, Coffey JC, et al. Provider volume and outcomes for oncological procedures[J]. Br J Surg, 2005, 92(4): 389-402.
53. 　van Gijn W. Volume and outcome in colorectal cancer surgery[J]. Eur J Surg Oncol, 2010,36(Suppl 1): 55-63.

West China Medical Journal

专业化和手术负荷对结直肠癌手术质量的影响

Abstract Full text Figures/Tables Video References Cited by

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