nach oben

International Journal of Colorectal Disease

Erschienen in:

01.05.2014 | Original Article

The impact of shortened postgraduate surgical training on colorectal cancer outcome

verfasst von: A. Currie, E. M. Burns, P. Aylin, A. Darzi, O. D. Faiz, P. Ziprin, on behalf of the Imperial College Healthcare NHS trust Colorectal Cancer MDT

Erschienen in: International Journal of Colorectal Disease | Ausgabe 5/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Shortened postgraduate surgical training reforms, known as Calman, have altered delivery of surgical training in the UK with reduced working hours and training time aiming to produce a more subspecialised workforce.

Aims

This study aims to compare rectal cancer surgical outcomes of Calman-trained consultants in a single institution to published data. Additionally, the study compared colorectal cancer surgical outcome between Calman-trained consultants (CTCs) and non-Calman consultants (NCTCs) in a national dataset.

Methods

Local dataset Clinicopathological outcome of rectal cancer resection undertaken by CTCs in a single institution (2006–2010) were compared against NCTC counterparts.

National dataset All elective colorectal cancer resections between 2004 and 2008 in English NHS hospitals were included. CTCs (present from 2004 onwards) were compared to NCTCs (present prior to 2004). Outcome measures included 30-day in-hospital mortality, reoperation and readmission rates.

Results

Local dataset One hundred thirteen patients were operated under five CTC. The 30-day in-hospital mortality for CTCs (1 %) was favourable compared to published rates (3–5 %). Local recurrence rate (4.4 %) was comparable to NCTC (3.6 %).

National dataset Between 2004 and 2008, 44,106 patients underwent elective colorectal resection. Multiple regression demonstrated CTC patients had a reduced length of stay and reduced reoperation rate. No difference in mortality and unplanned readmission rates were seen.

Conclusion

CTCs have similar safety outcome to NCTCs for colorectal cancer resection procedures. Further work is needed to assess the impact of further training reductions on clinical outcome.

Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20(7):1729–1734PubMedCrossRef

Bourne MC, Paterson-Brown S (1999) Calman and the new deal—compromising doctor training and patient care. Scott Med J 44(5):147–148PubMed

Bradford IM, Whittaker MG (1999) Specialist registrar training in surgical emergencies: concern for Calman training in the United Kingdom. Ann R Coll Surg Engl 81(5 Suppl):236–240PubMed

Clark CI, Lovett B (1998) Problems from Calman: shorter or longer time to consultant appointment in general surgery? Ann R Coll Surg Engl 80(5 Suppl):232–233PubMed

Kelty C, Duffy J, Cooper G (1999) Out-of-hours work in cardiothoracic surgery: implications of the New Deal and Calman for training. Postgrad Med J 75(884):351–352PubMedCentralPubMed

Skidmore FD (1997) Junior surgeons are becoming deskilled as result of Calman proposals. BMJ 314(7089):1281PubMedCentralPubMedCrossRef

Turton EP, Whiteley MS, Berridge DC, Scott DJ (1999) Calman, venous surgery and the vascular trainee. J R Coll Surg Edinb 44(3):172–176PubMed

Morris-Stiff G, Ball E, Torkington J, Foster ME, Lewis MH, Havard TJ (2004) Registrar operating experience over a 15-year period: more, less or more or less the same? Surgeon 2(3):161–164PubMedCrossRef

Collins JP (2011) International consensus statement on surgical education and training in an era of reduced working hours. Surgeon 9(Suppl 1):S3–5PubMedCrossRef

10.

Gough IR (2011) The impact of reduced working hours on surgical training in Australia and New Zealand. Surgeon 9(Suppl 1):S8–9PubMedCrossRef

11.

Abraham T, Freitas M, Frangos S, Frankel HL, Rabinovici R (2006) Are resident work-hour limitations beneficial to the trauma profession? Am Surg 72(1):35–41PubMed

12.

Connors RC, Doty JR, Bull DA, May HT, Fullerton DA, Robbins RC (2009) Effect of work-hour restriction on operative experience in cardiothoracic surgical residency training. J Thorac Cardiovasc Surg 137(3):710–713PubMedCrossRef

13.

Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26(2):303–312PubMedCrossRef

14.

Bosch SL, Nagtegaal ID (2012) The importance of the pathologist’s role in assessment of the quality of the mesorectum. Curr Color Cancer Rep 8(2):90–98CrossRef

15.

Faiz O, Warusavitarne J, Bottle A, Tekkis PP, Darzi AW, Kennedy RH (2009) Laparoscopically assisted vs. open elective colonic and rectal resection: a comparison of outcomes in English National Health Service Trusts between 1996 and 2006. Dis Colon Rectum 52(10):1695–1704PubMedCrossRef

16.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRef

17.

Carstairs V, Morris R (1989) Deprivation: explaining differences in mortality between Scotland and England and Wales. BMJ 299(6704):886–889PubMedCentralPubMedCrossRef

18.

Burns EM, Bottle A, Aylin P, Darzi A, Nicholls RJ, Faiz O (2011) Variation in reoperation after colorectal surgery in England as an indicator of surgical performance: retrospective analysis of Hospital Episode Statistics. BMJ 343:d4836PubMedCentralPubMedCrossRef

19.

von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457CrossRef

20.

ACPGBI (2012) The National Bowel Cancer Audit Project Report. The NHS Information Centre, London

21.

Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345(9):638–646PubMedCrossRef

22.

Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, Quirke P, Couture J, de Metz C, Myint AS, Bessell E, Griffiths G, Thompson LC, Parmar M (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373(9666):811–820PubMedCentralPubMedCrossRef

23.

Birbeck KF, Macklin CP, Tiffin NJ, Parsons W, Dixon MF, Mapstone NP, Abbott CR, Scott N, Finan PJ, Johnston D, Quirke P (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 235(4):449–457PubMedCentralPubMedCrossRef

24.

Enker WE, Thaler HT, Cranor ML, Polyak T (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181(4):335–346PubMed

25.

Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726PubMedCrossRef

26.

Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97(11):1638–1645PubMedCrossRef

27.

Almoudaris A, Clark S, Vincent C, Faiz O (2010) Establishing quality in colorectal surgery. Colorectal Dis

28.

Silber JH, Williams SV, Krakauer H, Schwartz JS (1992) Hospital and patient characteristics associated with death after surgery. A study of adverse occurrence and failure to rescue. Med Care 30(7):615–629PubMedCrossRef

29.

Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev (2):CD007635

30.

Morris AM, Baldwin LM, Matthews B, Dominitz JA, Barlow WE, Dobie SA, Billingsley KG (2007) Reoperation as a quality indicator in colorectal surgery: a population-based analysis. Ann Surg 245(1):73–79PubMedCentralPubMedCrossRef

31.

Birkmeyer JD, Hamby LS, Birkmeyer CM, Decker MV, Karon NM, Dow RW (2001) Is unplanned return to the operating room a useful quality indicator in general surgery? Arch Surg 136(4):405–411PubMedCrossRef

32.

Williams GL, Sagar PM, McAllister I, Gonsalves S (2009) The laparoscopic colorectal fellowships are popular, educational and produce competent laparoscopic surgeons. Color Dis 11(5):519–521CrossRef

33.

Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery - Comparison of right-sided and left-sided resections. Ann Surg 242(1):83–91PubMedCentralPubMedCrossRef

34.

Borowski DW, Bradburn DM, Mills SJ, Bharathan B, Wilson RG, Ratcliffe AA, Kelly SB (2010) Volume-outcome analysis of colorectal cancer-related outcomes. Br J Surg 97(9):1416–1430PubMedCrossRef

35.

Burns EM, Bottle A, Aylin P, Clark SK, Tekkis PP, Darzi A, Nicholls RJ, Faiz O (2011) Volume analysis of outcome following restorative proctocolectomy. Br J Surg 98(3):408–417PubMedCrossRef

36.

Faiz O, Haji A, Burns E, Bottle A, Kennedy R, Aylin P (2010) Hospital stay amongst patients undergoing major elective colorectal surgery: predicting prolonged stay and readmissions in NHS hospitals. Colorectal Dis

37.

Zaheer S, Pemberton JH, Farouk R, Dozois RR, Wolff BG, Ilstrup D (1998) Surgical treatment of adenocarcinoma of the rectum. Ann Surg 227(6):800–811PubMedCentralPubMedCrossRef

38.

MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341(8843):457–460PubMedCrossRef

39.

Holt PJ, Poloniecki JD, Hofman D, Hinchliffe RJ, Loftus IM, Thompson MM (2010) Re-interventions, readmissions and discharge destination: modern metrics for the assessment of the quality of care. Eur J Vasc Endovasc Surg;39(1):49-54

40.

Westaby S, Archer N, Manning N, Adwani S, Grebenik C, Ormerod O, Pillai R, Wilson N (2007) Comparison of hospital episode statistics and central cardiac audit database in public reporting of congenital heart surgery mortality. BMJ 335(7623):759PubMedCentralPubMedCrossRef

41.

Smalley W (2011) Administrative data and measurement of colonoscopy quality: not ready for prime time? Gastrointest Endosc 73(3):454–455PubMedCrossRef

42.

Lieberman D (2010) Pitfalls of using administrative data for research. Dig Dis Sci 55(6):1506–1508PubMedCrossRef

43.

Garout M, Tilney HS, Tekkis PP, Aylin P (2008) Comparison of administrative data with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) colorectal cancer database. Int J Color Dis 23(2):155–163CrossRef

44.

Aylin P, Lees T, Baker S, Prytherch D, Ashley S (2007) Descriptive study comparing routine hospital administrative data with the Vascular Society of Great Britain and Ireland’s National Vascular Database. Eur J Vasc Endovasc Surg 33(4):461–465, discussion 466PubMedCrossRef

45.

Almoudaris AM, Burns EM, Bottle A, Aylin P, Darzi A, Faiz O (2011) A colorectal perspective on voluntary submission of outcome data to clinical registries. Br J Surg 98(1):132–139PubMedCrossRef

46.

Burns EM, Rigby E, Mamidanna R, Bottle A, Aylin P, Ziprin P, Faiz OD (2011) Systematic review of discharge coding accuracy. J Public Health (Oxf)

47.

Bates T, Cecil E, Greene I (2007) The effect of the EWTD on training in general surgery: an analysis of electronic logbook records. Ann R Coll Surg Engl 89(suppl)):106–109CrossRef

48.

Aylin P, Bottle A, Majeed A (2007) Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models. BMJ 334(7602):1044PubMedCentralPubMedCrossRef

Titel: The impact of shortened postgraduate surgical training on colorectal cancer outcome
verfasst von: A. Currie
E. M. Burns
P. Aylin
A. Darzi
O. D. Faiz
P. Ziprin
on behalf of the Imperial College Healthcare NHS trust Colorectal Cancer MDT
Publikationsdatum: 01.05.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: International Journal of Colorectal Disease / Ausgabe 5/2014
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-014-1843-9

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Background

Aims

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2014

Improved outcome with multimodal treatment and imatinib rechallenge in advanced GIST

Overall survival is improved in mucinous adenocarcinoma of the colon

Tailored prolapse surgery for the treatment of haemorrhoids and obstructed defecation syndrome with a new dedicated device: TST STARR Plus

Prevention of colonic spasm using l-menthol in colonoscopic examination

Active ulcerative colitis diagnosed by 18F-FDG PET/CT in an anti-TNF alpha treated patient with no visible luminal lesions on colonoscopy

Emergency presentation of node-negative colorectal cancer treated with curative surgery is associated with poorer short and longer-term survival

Update Chirurgie