Outcome in patients with colorectal cancer managed by surgical trainees

Background: The surgeon is an important variable that influences outcome fo llowing colorectal cancer surgery. Operative training of suitable quality a nd quantity is essential if intersurgeon variation is to be reduced. The ai m of this study was to examine the outcome of colorectal cancer surgery whe n a high proportion of the operations were performed by trainee surgeons. Methods: A prospective 7-year (1989-1996) audit of 306 consecutive colorect al cancers referred to a single general surgeon with a colorectal interest was carried out. The outcome (anastomotic leakage, 30-day mortality rate, l ocal recurrence and cancer-related survival) of operations performed by the consultant was compared with that of his trainees. Results: Some 245 (92.5 per cent) of 265 patients undergoing laparotomy had a resection. Seventy (28.6 per cent) and 67 (27.3 per cent) of operations were performed by supervised and independent trainees respectively. There w as no difference between the consultant, supervised and independent trainee s for 30-day mortality rate (6.5, 6 and 4 per cent respectively), clinical anastomotic leakage rate (9, 2 and 5 per cent) and local recurrence rate (2 , 3 and 7 per cent). There was no difference between the three groups for a djusted 5-year disease-related survival rates. Conclusion: Properly supervised trainees can resect a high proportion of co lorectal cancers without compromising immediate outcome or long-term surviv al.