A. A. Khan1, S. Desai1, J. Mellinger1, S. Ganai1 1Southern Illinois University School Of Medicine,Springfield, IL, USA
Introduction: Resident case volume and complement has changed over the past decade, possibly due to an increase in minimally-invasive procedures and duty hour reform. Subspecialty fellowship training in complex general surgical oncology has recently received approval for board certification and has been advocated as a pathway to improve proficiency in the performance of complex open oncologic cases in addition to providing comprehensive exposure to the multidisciplinary management of cancer. The purpose of this paper is to evaluate trends in resident exposure to complex oncologic cases.
Methods: A retrospective analysis of National Accreditation Council for Graduate Medical Education (ACGME) case log statistical reports from 2000-2013 was conducted to determine resident case volume for selected oncology-relevant procedures. Average yearly case numbers combining both Surgeon Chief and Surgeon Junior categories were analyzed as cases per graduating resident using linear regression assessing for temporal trends, with the null hypothesis assuming an estimated slope of zero. The Spearman rho test was used to estimate correlation of case trends over time.
Results:Linear regression trends for oncology-relevant procedures are summarized in the attached table. Decreasing trends were observed for major lymphadenectomies (rho -0.93, p<0.0001) and modified radical mastectomy (rho -0.86, p=0.007) during the study period. There was no significant change in exposure to total gastrectomy (rho +0.33, p=0.43) and esophagectomy (rho -0.60, p=0.03). An increasing exposure was noted for hepatopancreaticobiliary cases including major hepatic resection (rho +0.93, p <0.0001) and pancreatectomy (rho +0.93, p <0.0001).
Conclusion:While decreases were noted for exposure to soft tissue lymphadenectomy, there were no differences in foregut cases and an increase in hepatopancreaticobiliary cases. The overall case numbers for several of these complex oncologic procedures remain low, justifying a need for further fellowship training depending on independent resident experience.
