Does the subspecialty of the surgeon performing primary colonic resection influence the outcome of patients with hepatic metastases referred for resection?

Objective To compare resection rates and outcome of patients subsequently r eferred with hepatic metastases whose initial colon cancers were resected b y surgeons with different specialty interests. Summary Background Data Variation in practice among noncolorectal specialis t surgeons has led to recommendations that colorectal cancers should be tre ated by surgeons trained in colorectal surgery or surgical oncology. Methods The resectability of metastases, the frequency and pattern of recur rence after resection, and the length of survival were compared in patients referred to a single center for resection of colorectal hepatic metastases . The patients were divided into those whose colorectal resection had been performed by general surgeons (GS) with other subspecialty interests (n = 1 08) or by colorectal specialists (CS; n = 122). Results No differences were observed with respect to age, sex, tumor stage, site of primary tumor, or frequency of synchronous metastases. Comparing t he GS group with the CS group, resectable disease was identified in 26% ver sus 66%, with tumor recurrence after a median follow-up of 19 months in 75% versus 44%, respectively. Recurrences involving bower or lymph nodes accou nted for 55% versus 24% of ail recurrences, with respective median survival s of 14 months versus 28 months. Conclusion Fewer patients referred by general surgeons had resectable liver disease. After surgery, recurrent tumor was more likely to develop in the GS group; their overall outcome was worse than that of the CS group. This o bservation is partly explained by a lower local recurrence rate in the CS g roup.