A new Mayo Clinic study shows that the type of surgeon and the type of hospital have a significant influence on long-term outcomes for patients who undergo surgery for rectal cancer.
The study, published in Cancer in May, looked at the characteristics of hospitals where people got their surgery, the surgeons who performed them and how those affect long-term survival. Most surgery for rectal cancer in the United States is performed by general surgeons. Only a minority of patients have their operation performed by a surgeon with subspecialty training in colorectal surgery.
The study found that patients who had surgery from a colorectal specialist had better long-term survival compared with those who had their operation performed by a general surgeon. Those patients who had their operations performed at National Cancer Institute designated Comprehensive Cancer Center also had significantly better outcomes.
“There really is an enormous burden on patients to find the right place to have their operation,” says David Etzioni, M.D., Mayo Clinic colorectal surgeon and lead author of the study. “A lot of times the pathways by which patients find their surgeon are very informal and it may not always serve the patient well.”
Researchers looked at records of more than 6,400 Medicare beneficiaries treated in the U.S. at more than 830 hospitals. The study points out that choices regarding treatment are complicated and are not always directly related to an estimation of outcomes. The geographic distribution of colorectal surgeons and NCI designated hospitals is imperfect -- most are located in large urban centers. Patients who don’t live in these areas are faced with a difficult decision, whether to receive care locally or travel to specialist surgeons or specialty hospitals.
“The upshot of this study is that patients, providers and payers who are interested in better long term outcomes should be directed to surgeons and hospitals with a focused expertise in rectal cancer treatment,” Dr. Etzioni added.
Rectal cancer is diagnosed in more than 40,000 people per year in the United States, and accounts for approximately 14,000 deaths.