Impact of surgeon's technique on outcome after treatment of rectal carcinoma

PURPOSE: The aim of this study was to analyze the impact of institutions and individual surgeons on long-term prognosis after curative resection of rectal carcinoma. METHODS: We used univariate and multivariate analysis of data from a German prospective, multicenter, patient-care evaluation study. RESULTS: The locoregional recurrence rates and the observed and cancer-related survival rates showed a considerable interinstitutional and intersurgeon variability. Multivariate analysis confirmed the institution and the individual surgeon as significant independent factors influencing locoregional recurrence and survival. There was a statistically highly significant correlation between the rate of locoregional recurrence and survival rate. CONCLUSIONS: The surgeon's technique and skill has to focus on prevention of locoregional recurrence to achieve good long-term outcome after curative resection for rectal carcinoma. New clinical trials on adjuvant treatment have to include quality assurance for surgery and pathology and documentation of the surgeon (as local code).Harry E Bacon Lectureship at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998. No reprints are available.