Our Summary

This study looked at the difference in outcome for patients who had specific types of bowel surgery (colectomy/proctectomy) performed by general surgeons compared to those who had the procedure done by surgeons specializing in colorectal (CR) surgery.

The researchers studied patient data from surgeries conducted in New York state between 2000 and 2014. They found that out of about 270,000 surgeries, around 26.7% were performed by CR surgeons.

Initially, the results showed that patients operated on by a CR surgeon had a lower chance of dying in the hospital. However, when the researchers took into account the volume of surgeries performed by the hospital and the individual surgeon, the difference was less pronounced, but still in favor of the CR surgeons.

This suggests that the experience of the hospital and surgeon (how many of these surgeries they do) explains about 53% of the drop in patient deaths when a CR surgeon does the operation.

In addition, patients treated by a CR surgeon spent less time in the hospital after surgery and were less likely to need a colostomy (a procedure to divert one end of the large intestine through an opening in the lower abdomen).

In simple terms, patients who needed bowel surgery had a better outcome if their operation was performed by a surgeon who specialized in colorectal surgery.

FAQs

  1. What was the purpose of the study on proctectomy surgeries?
  2. Did the data suggest that patients have better outcomes when their surgery is performed by a CR surgeon, as opposed to a general surgeon?
  3. What factors contribute to the drop in patient deaths when a CR surgeon performs the operation?

Doctor’s Tip

Therefore, a helpful tip a doctor might tell a patient about proctectomy is to consider seeking out a colorectal surgeon for the procedure, as they may have more experience and expertise in performing these types of surgeries, leading to better outcomes and potentially a quicker recovery. It’s important to do your research and choose a surgeon who specializes in colorectal surgery to ensure the best possible results.

Suitable For

Patients who are typically recommended proctectomy are those with conditions such as rectal cancer, inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease), familial adenomatous polyposis (FAP), or other conditions that affect the rectum. Proctectomy may be recommended as a treatment option when other treatments have not been effective or when there is a high risk of cancer developing in the rectum. Patients who are considering proctectomy should consult with a colorectal surgeon to determine if this procedure is the best course of action for their specific condition.

Timeline

Timeline before proctectomy:

  1. Patient experiences symptoms such as rectal bleeding, changes in bowel habits, abdominal pain, or a feeling of incomplete bowel emptying.
  2. Patient sees a doctor for evaluation and is diagnosed with a condition such as colorectal cancer, inflammatory bowel disease, or rectal prolapse.
  3. Patient undergoes preoperative testing and preparation for surgery, including imaging studies and bowel preparation.
  4. Patient discusses the risks and benefits of proctectomy with their surgeon and makes a decision to proceed with the surgery.

Timeline after proctectomy:

  1. Patient undergoes proctectomy surgery, which may be performed by a general surgeon or a colorectal surgeon.
  2. Patient recovers in the hospital for a few days, where they are monitored for complications and given pain management.
  3. Patient is discharged from the hospital and continues their recovery at home, following postoperative instructions from their surgeon.
  4. Patient may need to make dietary and lifestyle changes to support healing and prevent complications.
  5. Patient follows up with their surgeon for postoperative appointments to monitor their recovery and address any concerns.
  6. Patient may undergo additional treatments such as chemotherapy or radiation therapy, depending on the underlying condition that led to the proctectomy.

What to Ask Your Doctor

  1. What is the specific reason for recommending a proctectomy in my case?
  2. Are there any alternative treatment options available besides surgery?
  3. How many proctectomies have you performed in the past, and what is your success rate?
  4. What are the potential risks and complications associated with a proctectomy?
  5. How long is the recovery process expected to be, and what can I do to help speed up my recovery?
  6. Will I need a colostomy after the proctectomy, and if so, is it temporary or permanent?
  7. What type of follow-up care will be needed after the surgery?
  8. Are there any long-term effects or changes in bowel function that I should expect after a proctectomy?
  9. Will I need to make any dietary or lifestyle changes post-surgery?
  10. Are there any specific signs or symptoms that I should watch out for after the surgery that may indicate a complication?

Reference

Authors: Saraidaridis JT, Hashimoto DA, Chang DC, Bordeianou LG, Kunitake H. Journal: J Gastrointest Surg. 2018 Mar;22(3):516-522. doi: 10.1007/s11605-017-3625-5. Epub 2017 Nov 15. PMID: 29143213