From England, Korea and other countries researchers are learning what should be common sense: “The growing volume of evidence that surgical expertise has a significant impact on outcome is becoming increasingly hard to ignore” says Professor Ian Fentiman from London’s Guy’s Hospital. “The days of the occasional breast cancer surgeon are coming to an end.” He says the same holds true for other operations as well.
Researchers from Korea discovered that 95 per cent of breast cancer surgery readmissions were from hospitals performing less than 100 procedures a year.
There was a strong link between the volume of procedures a hospital carried out and the readmission rate. 71 per cent of the women had been treated at hospitals performing less than 50 breast cancer operations a year and a further 24 per cent had been treated at hospitals performing less than 100 procedures a year.
In his accompanying editorial to the paper, [Professor Fentiman] says that the Korean study adds to the growing body of evidence that breast cancer surgery is not for the occasional operator.
He adds that studies of other surgical procedures, including prostate cancer and operations on the pancreas and oesophagus, have also found significant differences between low and high volume institutions.
“Poor surgical technique has been linked to more complications and deaths” says Professor Fentiman. “This may become apparent immediately after complex surgery on vital organs such as the heart, but for breast cancer patients unnecessary deaths from inadequate procedures can take years to manifest.”
“Although workload and hence experience is a major determinant of outcome, it is expertise that is most important. However, there is normally a close correlation between the number of procedures a surgeon carries out and his or her level of expertise.”