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Bowel Resection Outcomes in Ovarian Cancer Cytoreductive Surgery by Surgeon Specialty
JAMA Surgery ( IF 15.7 ) Pub Date : 2024-08-07 , DOI: 10.1001/jamasurg.2024.2924
Jasmine Ebott 1, 2 , Phinnara Has 3 , Christina Raker 3 , Katina Robison 4
JAMA Surgery ( IF 15.7 ) Pub Date : 2024-08-07 , DOI: 10.1001/jamasurg.2024.2924
Jasmine Ebott 1, 2 , Phinnara Has 3 , Christina Raker 3 , Katina Robison 4
Affiliation
ImportanceExtensive bowel surgery is often necessary to achieve complete cytoreduction in patients with epithelial ovarian cancer. Regardless of who performs the surgery, it has been well documented that bowel resections are a high-risk procedure and an anastomotic leak is a severe complication that can occur. There are few studies addressing whether surgeon type impacts surgical outcomes in this patient population.ObjectiveTo compare surgical outcomes between gynecologic oncologist, general surgeons, and a 2-surgeon team approach for patients with advanced epithelial ovarian cancer who underwent bowel surgery during cytoreductive debulking.Design, Setting, ParticipantsThis retrospective cohort study used the American College of Surgeons’ National Surgical Quality Improvement Program datasets from 2012 through 2020. The aforementioned years of the dataset were analyzed from March 2022 to March 2023 and reanalyzed in May 2024 for quality assurance. Analysis of cytoreductive surgeries performed by a gynecologic oncologist, a general surgeon, or a 2-surgeon team approach for patients with ovarian cancer recorded in National Surgical Quality Improvement Program datasets was included. The 2-surgeon team approach included any combination of the aforementioned surgical specialties.Main outcome and measureThe primary outcome of interest was anastomotic leak after bowel surgery during ovarian cancer debulking.ResultsA total of 1810 patients were included in the study; in the general surgery cohort, mean (SD) patient age was 65.1 (11.1) years and mean (SD) body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) was 26.9 (7.4); in the gynecologic oncology cohort, mean (SD) patient age was 63.5 (11.7) years and mean BMI (SD) was 27.7 (6.5); and in the 2-surgeon team cohort, mean (SD) patient age 62.4 (12.1) years and mean (SD) BMI was 28.1 (7.0). Gynecologic oncologists performed 1217 cases (67.2%), general surgery performed 97 cases (5.4%), and 496 cases had 2-surgeon teams involved (27.4%). Bivariate analysis revealed an anastomotic leak rate of 3.6% for gynecologic oncologists, 5.2% for general surgeons, and 0.4% for cases that had 2 surgical teams involved (P < .001). By multivariable analysis, the adjusted odds ratio for anastomotic leak was 1.53 (95% CI, 0.59-3.96) for the general surgeon group (P = .38) vs an adjusted odds ratio of 0.11 (95% CI, 0.03-0.47) for the 2-surgeon team approach (P = .003) with the referent being gynecologic oncology.Conclusion and RelevanceIn this study, the anastomotic leak rate was found to be lower when 2 surgeons participated in the case, regardless of the surgical specialty. These results suggest that team-based care improves surgical outcomes.
中文翻译:
按外科医生专业划分的卵巢癌细胞减灭术的肠道切除结果
重要性上皮性卵巢癌患者通常需要进行广泛的肠道手术以实现完全细胞减灭术。无论谁进行手术,都有充分的证据表明,肠切除术是一种高风险手术,吻合口瘘是一种可能发生的严重并发症。很少有研究讨论外科医生类型是否会影响该患者群体的手术结果。目的比较妇科肿瘤科医生、普通外科医生和 2 人外科医生团队方法对细胞减瘤术期间接受肠道手术的晚期上皮性卵巢癌患者的手术结局。设计、设置、参与者这项回顾性队列研究使用了 2012 年至 2020 年美国外科医师学会的国家手术质量改进计划数据集。从 2022 年 3 月到 2023 年 3 月对数据集的上述年份进行了分析,并于 2024 年 5 月进行了重新分析以确保质量。包括对国家手术质量改进计划数据集中记录的妇科肿瘤学家、普通外科医生或 2 人外科医生团队对卵巢癌患者进行的细胞减灭手术的分析。2 人外科医生团队方法包括上述外科专业的任意组合。主要结局和测量感兴趣的主要结局是卵巢癌减瘤术期间肠道手术后吻合口瘘。结果共纳入 1810 例患者;在普通外科队列中,平均 (SD) 患者年龄为 65.1 (11.1) 岁,平均 (SD) 体重指数 (BMI) (计算为体重(公斤)除以身高(米)的平方)为 26.9 (7.4);在妇科肿瘤队列中,患者平均年龄 (SD) 为 63.5 (11.7) 岁,平均 BMI (SD) 为 27.7 (6.5);在 2 外科医生团队队列中,患者平均年龄 (SD) 为 62.4 (12.1) 岁,平均 (SD) BMI 为 28.1 (7.0)。妇科肿瘤科医生进行了 1217 例 (67.2%),普通外科进行了 97 例 (5.4%),496 例有 2 个外科医生团队参与 (27.4%)。双变量分析显示,妇科肿瘤科医生的吻合口瘘率为 3.6%,普通外科医生为 5.2%,有 2 个手术团队参与的病例为 0.4% (P < .001)。通过多变量分析,普通外科医生组吻合口瘘的校正比值比为 1.53 (95% CI,0.59-3.96) (P = .38),而 2 外科医生团队方法 (P = .003) 的调整比值比为 0.11 (95% CI,0.03-0.47),指涉妇科肿瘤学。结论和相关性在本研究中,发现当 2 名外科医生参与病例时,吻合口瘘率较低,无论手术专业如何。这些结果表明,基于团队的护理可以改善手术结果。
更新日期:2024-08-07
中文翻译:
按外科医生专业划分的卵巢癌细胞减灭术的肠道切除结果
重要性上皮性卵巢癌患者通常需要进行广泛的肠道手术以实现完全细胞减灭术。无论谁进行手术,都有充分的证据表明,肠切除术是一种高风险手术,吻合口瘘是一种可能发生的严重并发症。很少有研究讨论外科医生类型是否会影响该患者群体的手术结果。目的比较妇科肿瘤科医生、普通外科医生和 2 人外科医生团队方法对细胞减瘤术期间接受肠道手术的晚期上皮性卵巢癌患者的手术结局。设计、设置、参与者这项回顾性队列研究使用了 2012 年至 2020 年美国外科医师学会的国家手术质量改进计划数据集。从 2022 年 3 月到 2023 年 3 月对数据集的上述年份进行了分析,并于 2024 年 5 月进行了重新分析以确保质量。包括对国家手术质量改进计划数据集中记录的妇科肿瘤学家、普通外科医生或 2 人外科医生团队对卵巢癌患者进行的细胞减灭手术的分析。2 人外科医生团队方法包括上述外科专业的任意组合。主要结局和测量感兴趣的主要结局是卵巢癌减瘤术期间肠道手术后吻合口瘘。结果共纳入 1810 例患者;在普通外科队列中,平均 (SD) 患者年龄为 65.1 (11.1) 岁,平均 (SD) 体重指数 (BMI) (计算为体重(公斤)除以身高(米)的平方)为 26.9 (7.4);在妇科肿瘤队列中,患者平均年龄 (SD) 为 63.5 (11.7) 岁,平均 BMI (SD) 为 27.7 (6.5);在 2 外科医生团队队列中,患者平均年龄 (SD) 为 62.4 (12.1) 岁,平均 (SD) BMI 为 28.1 (7.0)。妇科肿瘤科医生进行了 1217 例 (67.2%),普通外科进行了 97 例 (5.4%),496 例有 2 个外科医生团队参与 (27.4%)。双变量分析显示,妇科肿瘤科医生的吻合口瘘率为 3.6%,普通外科医生为 5.2%,有 2 个手术团队参与的病例为 0.4% (P < .001)。通过多变量分析,普通外科医生组吻合口瘘的校正比值比为 1.53 (95% CI,0.59-3.96) (P = .38),而 2 外科医生团队方法 (P = .003) 的调整比值比为 0.11 (95% CI,0.03-0.47),指涉妇科肿瘤学。结论和相关性在本研究中,发现当 2 名外科医生参与病例时,吻合口瘘率较低,无论手术专业如何。这些结果表明,基于团队的护理可以改善手术结果。