Tumor surgeons: the more experience, the fewer complications and deaths

How many cases like mine do you treat each year? It may not be easy to ask this question to the doctor in front of you, but overcoming the embarrassment and getting an answer makes a big difference. Especially if the disease you suffer from is as complex as a tumor, because more and more research confirms this: the experience of surgeons is fundamental for the success of an operationto minimize the risk of complications and even mortality. It goes in this sense a study, coordinated by researchers at the IRCCS Policlinico di Sant'Orsola in Bologna and just published in the British Journal of Surgery, which examined almost 17 thousand cases of patients with colorectal cancer treated by 80 Italian hospitals between 2018 and 2021.

A new Italian study

We wanted to investigate the possible correlation between the successful outcome of the surgery and the occurrence of complications with the type of center in which the same pathology is treated – explains Matteo Rottoli, first author of the research and specialist in alimentary tract surgery at the hospital. – University of Bologna -. To be certain of the results we decided to collect a very high number of cases and that they came from numerous centers. The results indicate that for the treatment of colorectal cancer It is preferable to treat patients in centers that carry out a high volume of operations every year and with teams with specific skills and professionalism. In particular, the data demonstrate that the mortality rate after surgery is decidedly lower in centers with a high volume of operations (1.5%) compared to those that operate little (2.5%). The difference further increases in the subgroup of patients treated for rectal cancer, a particularly complex pathology from a surgical point of view. In this case, in fact, the mortality rate in high-volume hospitals (0.8%) is 63% lower than in low-volume centers (where the mortality rate stands at 2.2%). Not only that – he adds Gilberto Poggioli, director of Alimentary Tract Surgery and Emergencies at the Sant'Orsola Polyclinic -: hospitals where fewer cases are operated are also more exposed (+ 11%) to post-surgery complications. In fact, 48.7% of patients treated in low-volume centers had a severe, i.e. difficult, course compared to 37.7% of those treated by expert surgeons. And the risk of having surgery for non-radical rectal cancer is also 10% higher in low-volume centers: 36.5% versus 27.7% in large centers.

The complications

In addition to mortality, Postoperative complications and radicality of oncological surgery (i.e. the complete removal of the entire neoplasm, a fundamental prerequisite for greater success of the treatments), indicators such as the use of neo-adjuvant chemo and radiotherapy (i.e. before the scalpel) have been investigated to ensure that the operation can be less invasive, able to eliminate the neoplasm entirely and is more effective while also limiting the possibility of recurrence or metastasis. A better radicality of surgery is also reflected, when necessary, in a greater number of lymph nodes removed and in the ability to completely remove the tumor, which significantly increases the possibility of recovery – adds Poggioli -. Or to live better and longer with the neoplasm. Numerous other studies have reached the same conclusion, indicating how decisive both the experience of the surgeons and the presence of a specialized group made up of more experts who follow each individual case also in other types of cancer, such as that of the pancreas, prostate, of the stomach and breast, for which (for years now: it has been a pioneer in this area) the Breast Units have been created, specialized breast centers, where the higher the adherence to the guidelines, the better the experience of the specialists and the adoption of a multidisciplinary approach is guaranteed.

Always rely on expert hands

Where do I go to get treatment? this is the question that everyone asks themselves, especially when faced with a cancer diagnosis – comments Antonino Spinelli, head of colorectal surgery at the Humanitas Clinical Institute in Milan, one of the authors of the new study -. The advice is to always rely on expert hands to have more chances of recovery, to live longer and better because the numbers undoubtedly indicate better outcomes where a multidisciplinary approach is guaranteed. A suggestion that certainly applies to rare and little-known tumors, but also in the case of colorectal cancer with over 48 thousand new cases registered every year, the second most frequent type of tumor in our country and also the second in the little-coveted ranking of the most lethal despite there being an effective way to diagnose it at the beginning and save your life: screening (offered free in Italy to all people between 50 and 70 years old) with the Sof test, to search for occult blood in the faeces. rest, it's not just about “quantity” in terms of numbers of patients and operations – concludes Rottoli -. We are talking about highly innovative and technological centers, where specialized professionals work with the support of cutting-edge equipment, such as robotic platforms. But above all, places devoted to scientific research as an ally of clinics, surgery and assistance.

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