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. 2001 May;84(10):1308–1313. doi: 10.1054/bjoc.2001.1794

Volumes of cancer surgery for breast, colorectal and ovarian cancer 1992–97: is there evidence of increasing sub-specialization by surgeons?

K Jolly 1, J Parry 1, A Rouse 1, A Stevens 1
PMCID: PMC2363641  PMID: 11355939

Abstract

The ‘Calman–Hine Report’ (1995) recommended that cancer surgery should be limited to ‘high-volume’ consultants. Through an analysis of 5 years of Hospital Episode Statistics for the West Midlands region (1992–1997), we have investigated whether there is evidence of increasing numbers of patients with breast, colorectal or ovarian cancer being treated by high throughput, i.e. sub-specialist surgeons, who carry out more than a threshold level of primary cancer resections annually. The proportion of cases treated by the high-volume breast, colorectal and ovarian cancer surgeons increased annually during the 5 years. The absolute number of consultant firms who undertook breast cancer resections reduced during the 5 years; but the number doing colorectal and ovarian surgery increased. Throughout the 5 years, half of the ovarian cancer resections were carried out by consultant firms who did very few procedures – less than 5 of these procedures annually. The relatively high case-load, the elective nature of breast cancer surgery and an early policy change have undoubtedly facilitated the move towards sub-specialization. The weaker trends for colorectal and ovarian cancer surgery suggest continued monitoring is required to ensure that there is a reduction in the proportion of people treated by surgeons who undertake few cancer resections annually. © 2001 Cancer Research Campaign www.bjcancer.com

Keywords: breast neoplasms, colorectal neoplasms, ovarian neoplasms, volume of clinical activity

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Selected References

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  1. Fielding L. P., Stewart-Brown S., Blesovsky L., Kearney G. Anastomotic integrity after operations for large-bowel cancer: a multicentre study. Br Med J. 1980 Aug 9;281(6237):411–414. doi: 10.1136/bmj.281.6237.411. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Gillis C. R., Hole D. J. Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland. BMJ. 1996 Jan 20;312(7024):145–148. doi: 10.1136/bmj.312.7024.145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Hermanek P., Hohenberger W. The importance of volume in colorectal cancer surgery. Eur J Surg Oncol. 1996 Jun;22(3):213–215. doi: 10.1016/s0748-7983(96)80004-7. [DOI] [PubMed] [Google Scholar]
  4. Junor E. J., Hole D. J., Gillis C. R. Management of ovarian cancer: referral to a multidisciplinary team matters. Br J Cancer. 1994 Aug;70(2):363–370. doi: 10.1038/bjc.1994.307. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kehoe S., Powell J., Wilson S., Woodman C. The influence of the operating surgeon's specialisation on patient survival in ovarian carcinoma. Br J Cancer. 1994 Nov;70(5):1014–1017. doi: 10.1038/bjc.1994.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. McArdle C. S., Hole D. Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. BMJ. 1991 Jun 22;302(6791):1501–1505. doi: 10.1136/bmj.302.6791.1501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Mella J., Biffin A., Radcliffe A. G., Stamatakis J. D., Steele R. J. Population-based audit of colorectal cancer management in two UK health regions. Colorectal Cancer Working Group, Royal College of Surgeons of England Clinical Epidemiology and Audit Unit. Br J Surg. 1997 Dec;84(12):1731–1736. [PubMed] [Google Scholar]
  8. Nguyen H. N., Averette H. E., Hoskins W., Penalver M., Sevin B. U., Steren A. National survey of ovarian carcinoma. Part V. The impact of physician's specialty on patients' survival. Cancer. 1993 Dec 15;72(12):3663–3670. doi: 10.1002/1097-0142(19931215)72:12<3663::aid-cncr2820721218>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  9. Parry J. M., Collins S., Mathers J., Scott N. A., Woodman C. B. Influence of volume of work on the outcome of treatment for patients with colorectal cancer. Br J Surg. 1999 Apr;86(4):475–481. doi: 10.1046/j.1365-2168.1999.01064.x. [DOI] [PubMed] [Google Scholar]
  10. Phillips R. K., Hittinger R., Blesovsky L., Fry J. S., Fielding L. P. Local recurrence following 'curative' surgery for large bowel cancer: I. The overall picture. Br J Surg. 1984 Jan;71(1):12–16. doi: 10.1002/bjs.1800710104. [DOI] [PubMed] [Google Scholar]
  11. Pollock A. M., Vickers N. Trends in colorectal cancer care in southern England, 1989-1993: using HES data to inform cancer services reviews. J Epidemiol Community Health. 1998 Jul;52(7):433–438. doi: 10.1136/jech.52.7.433. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Porter G. A., Soskolne C. L., Yakimets W. W., Newman S. C. Surgeon-related factors and outcome in rectal cancer. Ann Surg. 1998 Feb;227(2):157–167. doi: 10.1097/00000658-199802000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Sagar P. M., Hartley M. N., MacFie J., Taylor B. A., Copeland G. P. Comparison of individual surgeon's performance. Risk-adjusted analysis with POSSUM scoring system. Dis Colon Rectum. 1996 Jun;39(6):654–658. doi: 10.1007/BF02056945. [DOI] [PubMed] [Google Scholar]
  14. Sainsbury R., Haward B., Rider L., Johnston C., Round C. Influence of clinician workload and patterns of treatment on survival from breast cancer. Lancet. 1995 May 20;345(8960):1265–1270. doi: 10.1016/s0140-6736(95)90924-9. [DOI] [PubMed] [Google Scholar]
  15. Schrag D., Cramer L. D., Bach P. B., Cohen A. M., Warren J. L., Begg C. B. Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA. 2000 Dec 20;284(23):3028–3035. doi: 10.1001/jama.284.23.3028. [DOI] [PubMed] [Google Scholar]

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