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Surgeon technical skill has big impact on colon-cancer outcomes

JAMA Oncology
Reuters Health - 06/11/2020 - The technical skills of the surgeon have a considerable impact on patient outcomes followings colon-cancer surgery, according to a new study.

"It may seem obvious but it's the first time ever demonstrated - surgeon technical skill (measured objectively) in removing the cancer results in better long-term cancer survival," lead author Dr. Karl Bilimoria of Northwestern Medicine, in Chicago, told Reuters Health by email.

The study team recruited 15 surgeons from the Illinois Surgical Quality Improvement Collaborative (ISQIC) in 2016 to participate in a video-based program to assess surgeons' technical skills. Each surgeon was videotaped while performing laparoscopic right hemicolectomy.

"Measuring and improving surgeon technical skills via video is now an area of surgery that is really taking off," Dr. Bilimoria told Reuters Health.

The surgeon's technical skill was scored by other surgeons, including peers and expert reviewers, using the American Society of Colon and Rectal Surgeons Video Assessment Tool. The researchers then assessed the outcomes of 609 patients who underwent laparoscopic colectomy performed by the participating surgeons.

Overall survival at five years was 79% for high-skill surgeons compared with 55% for medium-skill and 60% for low-skill surgeons. Each 0.1-point skill-score increment was associated with a higher likelihood of survival (hazard ratio, 0.90, P=0.01).

"This is pretty mind blowing. The long-term effect is huge. It may seem common sense in some ways, but we didn't realize the magnitude of the effect," Dr. Bilimoria said in news release.

The five surgeons with the highest technical skill scores also had the highest volume of procedures in the study, and the highest average annual number of surgical cases.

Dr. Bilimoria suggests patients ask their surgeon how many of procedures they regularly perform. "Volume of cases is a reflection of expertise. Patients also can ask their surgeon what he or she does to stay up to date and improve skills. These questions can help patients make informed decisions about where to seek care," he said in the release.

Limitations of the study include the small number of surgeons and skill assessment based on a single video.

By Megan Brooks

SOURCE: https://bit.ly/32ja9iq JAMA Oncology, online October 30, 2020.

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