farella-结直肠癌外科进展 PPT.ppt

The type of operation and the surgeon as factors affecting oncological outcome in rectal cancer surgery;EPIDEMIOLOGY;RECTAL CANCER;Evolving concepts in surgical strategy;Variability in results;Surgical options;Trans-anal techniques;Trans-anal techniques;Selection criteria for curative trans-anal treatment;Tumor stage andrisk of nodal involvement;Curative trans-anal treatment: results;RECTAL CANCER TREATED BY TRANSANAL EXCISION;Rectal cancer;Distal margin;Variations in distal margin according to specimen setting;Lateral margins;RJ Heald et al, Br J Surg 1982; 69:613-616;TME and local recurrence;TOTAL MESORECTAL EXCISION;Rectal Cancer;Rectal Cancer;Rectal Cancer;Rectal Cancer;The surgeon as factor affecting oncological outcome;The surgeon as prognostic factor;Improved results can be obtaineed through:;Surgical volume and results;Comparison* between general surgery and colorectal surgery residents’ activity;General Surgeon vs. Colorectal Surgeon;P Hermanek, W Hohenberger, Eur J Surg Oncol 1996; 22:213-215; 683 cases of rectal cancer operated by “CRT surg.” and “NCRT surg.” in 8 years. Low rectal anastomoses much more frequent for “CRT surg.” (p0.001). APR much more frequent for “NCRT surg.”(p0.001). Local recurrence much more frequent for “NCRT surg.” (p=0.001). Better survival for “CRT surg.” (p=0.005). Surgeons performing ≥ 21 operations in the considered period had better results than those performing 21 (p=0.001). “CRT surg.” with ≥ 21 operations in the considered period had the best results (p=0.005).; 9793 operations for colorectal cancer performed by 812 surgeons in 50 hospitals. Year volume/surgeon: low (5), middle (5-10), high (10). Year volume/hospital: low (40), middle (40-70), high (70). Surgeons with higher volume obtained better results in terms of mortality, hospitalization and costs. Surgeons with “middle volume” obtained results close to “high volume” colleagues if working in “high volume” hospitals.; 378 cases