專業化和手術負荷對結直腸癌手術質量的影響_《華西醫學》

作者：

胡雪姣 ^1,2 , 馬琛 ¹ , 羅翼 ² , 汪曉東 ^1,2 ,  李立 ¹

四川大學（成都，610041） 1 華西醫院胃腸外科中心，2 華西臨床醫學院;

關鍵詞：

專業化手術負荷手術容量結直腸癌手術質量

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【摘要】　目前國內外學者常通過醫生專業化程度、醫生手術負荷量以及醫院手術容量3個較為主觀的指標來評價醫生與醫院因素對結直腸癌患者手術效果和生存預后的影響程度。這從醫生和醫院的角度為結直腸癌手術質量評估體系增添了新的內容，對醫學生和年輕醫生的培養提供了專業技能訓練的指導。現就醫生的專業化程度和負荷量、醫院手術容量在結直腸癌手術中所起作用的研究近況進行綜述。

引用本文： 胡雪姣,馬琛,羅翼,汪曉東,李立. 專業化和手術負荷對結直腸癌手術質量的影響. 華西醫學, 2011, 26(8): 1259-1263. doi: 復制

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, 汪曉東, 舒曄, 等. 四川大學華西醫院?結直腸癌手術治療指南(一)[J]. 中國普外基礎與臨床雜志, 2008, 15(10): 778.
5.	汪曉東, 曹霖, 呂東昊, 等. 多學科協作診治模式下結直腸癌新輔助化療聯合手術的風險評估研究[J]. 中國普外基礎與臨床雜志, 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.
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, 汪曉東, 舒曄, 等. 四川大學華西醫院?結直腸癌手術治療指南(一)[J]. 中國普外基礎與臨床雜志, 2008, 15(10): 778.
5. 　汪曉東, 曹霖, 呂東昊, 等. 多學科協作診治模式下結直腸癌新輔助化療聯合手術的風險評估研究[J]. 中國普外基礎與臨床雜志, 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.
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.

《華西醫學》

專業化和手術負荷對結直腸癌手術質量的影響

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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《華西醫學》

專業化和手術負荷對結直腸癌手術質量的影響

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料