The authors
of a research letter published online in JAMA Oncology have suggested an
association between surgical technical skill and long-term survival following
colon cancer surgery.

Brian C.
Brajcich, M.D., from the American College of Surgeons in Chicago, and
colleagues recruited surgeons participating in the 2016 Illinois Surgical
Quality Improvement Collaborative for a video-based technical skills
assessment, with each surgeon submitting one representative video of a
laparoscopic right hemicolectomy.

Review was
performed by 12 or more surgeons, including two colorectal surgeons with video
evaluation experience.

The National
Cancer Database was used to identify patients who underwent any minimally
invasive colectomy for stage I to III epithelial-origin colon cancer; patients
with operations performed by participating surgeons were matched by National
Provider Identifier numbers.

Based on 609
patients who underwent laparoscopic colectomy at 11 hospitals performed by one
of 15 participating surgeons, the researchers found that overall survival
differed among skill terciles (five-year survival: 79 percent for the
high-skill tercile, 55 percent for the medium-skill tercile, and 60 percent for
the low-skill tercile). Survival was improved for the high-skill versus
low-skill tercile after adjusting for patient characteristics (hazard ratio
[HR], 0.31).

There was a
higher likelihood of survival with each 0.1-point skill score increment (HR,
0.90). The association between skill and outcomes was strongest among patients
with stage II disease (high- versus low-skill tercile: HR, 0.14; medium- versus
low-skill tercile: HR, 0.12). Among 307 open procedures, a survival advantage
was seen with high-skill surgeons (HR, 0.41) and medium-skill surgeons (HR,
0.41) compared with the low-skill tercile.

may affect survival through oncologic resection quality (e.g., lymph node
harvesting) or may reflect surgeon characteristics, such as operative volume or
guideline adherence,” the authors suggested.


Brajcich et al:
 Association Between
Surgical Technical Skill and Long-term Survival for Colon Cancer;