New evidence shows that now more than ever, colorectal surgeons are important. In a review published in the December edition of Seminars in Colorectal Surgery, Patel et al. discuss some current trends.
Colorectal surgeons perform a variety of complex procedures, including surgery for colon cancer. At least five different studies (referenced below) examining the effect of colorectal specialty training for colon cancer treatment have shown increased survival, more use of minimally invasive techniques, and lower leak/recurrence rates among specialists. Furthermore, there were lower rates of permanent stomas in the treatment of rectal cancer.
Colorectal surgeons undergo rigorous specialty training with strict requirements. Consider that the average general surgeon performs only 19 colon resections per year, according to a recent published study in JACS. When you add to this that the learning curve for laparoscopic colorectal surgery can be upwards of 50 cases, specialty training becomes increasingly important. Other studies have shown that the learning curve can be much higher (100-150 cases in a self-training environment vs. 40 in a fellowship setting). A Cochrane review showed outcomes for colon cancer were better among specialists, which can include other types of advanced minimally invasive training.
In treating anorectal diseases, data from the American Board of Surgery suggests many general surgeons only do a handful of cases per year. Most trainees without additional fellowship experience have not reached the learning curve volume required for many of these procedures, which include hemorrhoidectomy, fistulectomy, and more. Finally, without specialized training, there are high rates of misdiagnosis.