Cancer survival far greater with specialist surgeons

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The Independent Online
PATIENTS with pancreatic cancer who are operated upon by specialist surgeons are up to six times more likely to survive the experience, according to new research.

A team of doctors who looked at the survival of patients found that in non-specialist hospitals, death rates ranged up to 30 per cent, but among pancreatic surgeons, fewer than six per cent of patients died.

The research comes in the wake of other studies which have shown that survival chances from both breast and colon cancer are much better when specialist doctors carry out the operation rather than general surgeons.

But the problem is that many patients do not know their surgeon is not a specialist. They assume that because the surgeon is consultant, he or she must be a specialist.

The problem is further compounded by the reluctance of British patients to seek second opinions - something taken for granted by their American counterparts.

The latest research, carried out by Professor John Neoptolemos of the University of Liverpool's department of surgery, together with his colleagues, shows that of those patients who went to a specialist centre, 94 per cent were still alive after 30 days. But when they looked at figures for general hospital, they found that little more than 70 per cent of patients were alive after the same period of time.

"These are really awful figures and the message is that general surgeons should not do pancreatic cancer operations," said Prof Neoptolemos.

"However, patients are continuing to go to general surgeons. Some are okay, but quite often they shy away from surgery because it is a risky operation and rather than refer the patient on to someone who can deal with it, they tell the patient they have got an inoperable cancer, that there's no other treatment for them.

"Then there will be few who will try the surgery now and then and do okay now and again.

"One of the problems is that the patient doesn't know. In one hospital you might find that the general surgeon there has already lost one or two patients and tells the patient there is nothing that can be done, but in another hospital the surgeon is a bit more cavalier. He thinks he can do it and off he goes."

In a report of their research in the British Journal of Surgery, the Neoptolemos team says: "The data argue strongly in favour of concentrating pancreatic surgery into specialised units and should encourage a higher referrals rate exclusively to such units."

A study in breast cancer patients in Scotland, which found significant differences in survival rates between specialist and non-specialist surgeons, came to a similar conclusion.

The five-year survival rate among patients was 10 per cent higher with specialist surgeons and the risk of dying was 26 per cent less. Had all women in Scotland received the same specialist service, around 850 more women would have still been alive after five years.

The report on that research by a team from the West of Scotland Cancer Surveillance Unit says: "This study points to there being a substantial survival benefit for patients cared for by specialists. We believe that future care of patients with breast cancer should be provided through specialist units."

A third study has also shown better survival rates among colon cancer patients dealt with by specialists.

One of the problems for general surgeons has been that until recently they dealt with the bulk of surgery. But over the past few decades, specialists have been breaking away gradually from orthopaedics to heart surgery.

As techniques have become more complicated and concentrated - and vascular surgeons are the latest to strain at the leash - the need for a greater range of specialists has become clear.