IS THE SURGEON A FACTOR WITH PROGNOSTIC R ELEVANCE AFTER R0-RESECTIONOF COLORECTAL-CARCINOMA

Although the principles of resection of colorectal carcinoma have been defined quite exactly, some studies report considerable variations in recurrence rate and survival between different surgeons and clinics. We have therefore evaluated whether this surgeon-related influence can be found within one surgical department if operative procedures are s trictly standardized. The data of 651 patients who underwent R0-resect ion of colorectal carcinoma between 1980 and 1992 was evaluated. Since all resections were accomplished by 5 groups of surgeons who strictly obeyed the same principles of resection, patients were divided in 5 g roups. These 5 groups showed similar distribution of age, sex, tumor l ocation, operative procedures and UICC-tumor-stages. The locoregional recurrence rate ranged from 1.7 %-13.3 % in stage I (p > 0.05), 9.3-20 .6 % in stage II (p > 0.05) and 13.6-52.4 % in stage III (p < 0.05). M etachronous distant metastases occurred in 3.2 to 13.3 % in stage I (p > 0.05), 2.9 to 16.7 % in stage II (p > 0.05) and 21.8 to 30.2 % in s tage III (p > 0.05). 5-year-survival-rates of the 5 groups of patients varied from 74.4-84.5 % in stage I (p > 0.05), 61.6-76.8 % in stage I I (p > 0.05), and 38.1 to 57.7 % in stage III (p < 0.05). Although the surgeon-related variability of these results was surprisingly high, m ultivariate analysis did not show the surgeon as a significant prognos tic factor. If the same principles of resection are strictly obeyed wi thin one department of surgery, the surgeon is not a factor of prognos tic significance. Because significant variations in locoregional recur rence and survival are observed between different hospitals and the in nerhospital variability of long-term results is rather high it is inev itable to consider the clinic and the surgeon as a factor of prognosti c relevance in prospective multicenter studies concerning the treatmen t of colorectal carcinoma.