The Surgeon and Surgical Procedure as Prognostic Factors

Surgical oncology themes at the 1997 European Cancer Conference (ECCO 9) included the need for meticulous surgery and the need for surgeons to develop and implement guidelines for the management of cancer.

For example, Professor Werner Hohenberger of the University Hospital, Erlanger, Germany, presented evidence showing that patients treated surgically for colorectal cancer do best if their surgeon follows a quality management program (practice guidelines). However, he also emphasized that other factors, such as which surgeon operates and in which institution the operation is performed, can also be vitally important.

He explained: “We studied patients with colorectal cancer who were treated in seven German institutions and followed up for at least 5 years, and the results of our study show that adhering to the steps of a quality management program is the most important factor to influence long-term outcome after surgery.”

“However,” Professor Hohenberger continued, “as far as locoregional recurrences were concerned, we found that the institution where the operations took place had an independent effect on the outlook and that in three institutions where the surgeons performed more than 100 operations in the recruitment period, individual surgeons could be identified as a prognostic factor.”

“From the data available, we conclude that centralization, specialization, and volume of surgery do not in themselves guarantee high quality, but it seems important for surgeons to have a certain amount of experience, and a special interest in the field may be a basic requisite for good outcome. However, adherence to the steps of a quality program is the most important factor to influence outcome.”

Professor Hohenberger’s conclusions about the importance of following standardized procedures were echoed by Professor Markus Büchler of the Department of Visceral and Transplantation Surgery, University Hospital, Bern, Switzerland.

“Recent data show a significant drop in mortality for major pancreatic resections for cancer. To find the reason for this, we reviewed 152 patients with pancreatic cancer and concluded that, in a specialist center with standardized preoperative assessment and operative technique combined with experience, even patients with preoperative risk factors can undergo major pancreatic surgery with good results.”