Poor postoperative outcomes following colon cancer (CC) resection are influenced by multiple factors, including both patient-related characteristics as well as surgeon-related factors. However, the influence of surgical specialization, surgeon resection volume and surgeon gender on patient’s postoperative out- come, after complex procedures such as emergency CC resection, remains incompletely understood.This thesis investigates the impact of surgeon-related factors on postoperative morbidity, mortality and long-term survival after CC surgery.The thesis is based on four papers, all built on register data retrieved from the Swedish Colorectal Cancer Registry (SCRCR), primarily focusing on emergency procedures, but Paper III also includes elec- tive procedures. The study cohorts included adult patients who underwent CC resections between Jan- uary 1, 2010, and December 31, 2020. A standardized review manual was used to validate registry data and extract additional variables from the patients’ medical records. In Paper I, Paper II and Paper III a cohort of patients from Helsingborg hospital was used, whereas Paper IV includes a multicenter cohort involving ten hospitals in the southern of Sweden. Outcomes were analyzed using logistic regression for binary variables and Kaplan-Meier and Cox regression methods for survival analyses.In paper I, short-term postoperative outcomes were compared across surgeons with different special- izations and annual resection volumes. Complication rates were similar between colorectal surgeons (CS) and acute care surgeons (ACS) but were higher among patients operated on by general surgeons (GS). Complication rates were most frequent among surgeons with the highest annual resection vol- umes. Mortality rates did not differ across surgeon specialty or volume categories.Paper II demonstrated that the long-term survival was comparable in patients operated on by CS and ACS, but significantly shorter in patients undergoing emergency resections by GS.Paper III showed no surgeon gender-related differences in outcomes among patients undergoing elective CC resections. However, after emergency resections, patients treated by female surgeons had fewer postoperative complications, fewer non-radical (R1) resections, fewer reoperations, and required less care at the Intensive Care Unit (ICU). Although the 30-day mortality was similar for patients operated on by male and female surgeons, long-term survival was significantly shorter among patients operated on by male surgeons.Paper IV validated the findings in paper III, in a multicenter setting. Results showed fewer complica- tions and reoperations for patients operated on by female surgeons, but no difference in short-term mor- tality between groups of patients. Long-term survival was shorter among patients operated on by male surgeons.Across the included studies, surgeon-related factors were found to influence the patients’ postopera- tive outcomes after emergency CC resection. The observed disparities, particularly those associated with surgeon gender, emphasize the importance to further investigate the underlying mechanisms driving these disparities.
Jenny Christina Engdahl Severin (Thu,) studied this question.