Influence of individual surgeon volume on early postoperative outcomes after rectal cancer resection

Zoran Aleksić; Maja Vulović; Bojan Milošević; Aleksandar Cvetković; Dragan Tomić; Nebojša Trkulja; Milan Simatović; Anđelka Stojković; Anita Ivošević

doi:10.2298/VSP171020187A

Zoran Aleksić University Clinical Center of the Republic of Srpska, Clinic for General and Abdominal Surgery, Banjaluka, Bosnia and Herzegovina
Maja Vulović University of Kragujevac, Faculty of Medical Sciences, Department of Anatomy and Forensic Medicine, Kragujevac, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Bojan Milošević Clinical Center Kragujevac, General and Thoracic Surgery Department, Kragujevac, Serbia
Aleksandar Cvetković Clinical Center Kragujevac, General and Thoracic Surgery Department, Kragujevac, Serbia
Dragan Tomić University Clinical Center of the Republic of Srpska, Clinic for General and Abdominal Surgery, Banjaluka, Bosnia and Herzegovina
Nebojša Trkulja University Clinical Center of the Republic of Srpska, Clinic for General and Abdominal Surgery, Banjaluka, Bosnia and Herzegovina
Milan Simatović University Clinical Center of the Republic of Srpska, Clinic for General and Abdominal Surgery, Banjaluka, Bosnia and Herzegovina
Anđelka Stojković University of Kragujevac, Faculty of Medical Sciences, Department of Pediatrics, Kragujevac, Serbia
Anita Ivošević University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP171020187A

Keywords: krvarenje, hospitalizacija, dužina, hirurzi, hirurgija, operativne procedure, rana, hirurška, dehiscencija, rektum, neoplazme, preživljavanje, lečenje, ishod

Abstract

Apstrakt

Uvod/Cilj. Individualno hirurško iskustvo mereno brojem procedura može značajno uticati na preživljavanje bolesnika sa karcinomom rektuma (KR). Cilj ovog rada bio je da se utvrdi da li individualni volumen procedure hirurga utiče na rane postoperativne ishode i da li jačina različitih grupa procedura hirurškog volumena, kao predskazatelja ishoda kod bolesnika sa KR do 30 dana posle hirurškog lečenja. Metode. Sprovedena je retrospektivna jednocentrična studija sa kohortom od 546 bolesnika oba pola, elektivno operisanih u 10-godišnjem period zbog KR. Bolesnici su bili podeljeni u tri grupe, shodno godišnjem volumenu procedura 18 ordinirajućih hirurga u kolorektalnoj hirurgiji. Analizirano je sedam ishoda: stopa dehiscencije kolorektalne anastomoze (DKRA), vreme trajanja operacije, intraoperativni gubitak krvi, dužina hospitalizacije, intrahospitalna smrtnost, patohistološki status cirkumferencijalne resekcione margine (CRM) i totalna mezorektalna ekscizija (TME) sa brojem limfnih nodusa, kao i drugi faktori rizika (više nezavisnih, zavisnih i “zbunjujućih” varijabli) od značaja za ishod operativnog lečenja i objašnjenje razlike. Utvrđivana je jačina svake grupe hirurga i njihov uticaj na rane ishode lečenja. Rezultati. Većina hirurga (77,7%) pripadala je grupi sa niskim i srednjim volumenom procedura koja je izvela nešto veći broj operacija (281). Grupa hirurga sa visokim volumenom imala je značajno bolje rezultate u četiri ishoda (stopa DKRA, vreme trajanja operacije, status CRM I TME sa brojem limfnih nodusa). Zaključak. U našoj hirurškoj ustanovi, visoki hirurški volumen je važan predskazatelj uspešnog ishoda u hirurškom lečenju karcinoma rektuma.

Author Biography

Zoran Aleksić, University Clinical Center of the Republic of Srpska, Clinic for General and Abdominal Surgery, Banjaluka, Bosnia and Herzegovina

NE

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