The influence of surgeon case volume on outcome in site-specific cancer surgery

Current evidence would not support the notion that casevolume in itself is important for achieving good results in cancer surgery. It is, however, becoming increasingly clear that specialist interest is important, and it is not too difficult to guess at the reasons for this seeming paradox. In areas where surgical skill is paramount, such as in rectal cancer surgery, the specialist will be familiar with the relevant anatomy and techniques so that good results will be achieved, even though relatively small numbers of cancers may be treated. In conditions where a multi-disciplinary approach is vital, such as breast or ovarian cancer, the specialist surgeon will be acutely aware of the necessity for non-surgical forms of treatment. The generalist, on the other hand, may not appreciate the nuances of surgical technique or the availability of adjuvant therapy which are required to achieve the best results. Thus, despite a high case volume he or she might obtain suboptimal results, either through ignorance or through pure haste engendered by pressure of work.