Condition of oncosurgical care and education in oncosurgery in the Czech Republic
Miloslav Duda1, Jan Žaloudík2, Miroslav Ryska3, Ladislav Dušek4,5
1 II. chirurgická klinika LF UP a FN Olomouc a Chirurgické odd. KOC Nový Jičín
2 Klinika komplexní onkologické péče LF MU, MOU, Brno
3 Chirurgická klinika 2. LF UK a ÚVN – VFN v Praze
4 Ústav zdravotnických informací a statistiky ČR, Praha
5 Institut biostatistiky a analýz LF MU, Brno
The aim of this work is to demonstrate the epidemiological situation regarding the incidence of solid malignant tumours and point out the current status and significance of surgery in the treatment of oncologic patients in the Czech Republic (CR), with special emphasis on the co-operation with gastroenterologists in digestive oncology during the diagnosis and therapy for gastrointestinal tract (GIT) tumours. We are describing the situation in the CR upon application of the principle of high-volume hospitals and the situation regarding education of surgeons in oncosurgery.
Materials and methods: The role of surgery in the care of patients with solid tumours is documented based on statistical data obtained from the National Oncologic Registry (NOR) in the Czech Republic.
Results: The number of newly diagnosed solid tumours in the CR is constantly increasing; between 2006 and 2010 on average 70,000 suffered from this disease each year. Over 49,000 patients underwent surgery (70.8%). Various surgical specialisations participate in the surgical treatment of solid tumours based on their localisation. Surgeons operated on 37,316 patients, which is 75.3% of all primarily operated solid malignant tumours in the CR. There were 7,319 urological surgeries per year (14.8% of patients who underwent surgery), 3,193 oncogynecological surgeries (6.4%), 1,211 head and neck surgeries (2.4%), and 523 neurosurgical procedures (1.1%). The majority of oncosurgical surgeries were performed for skin tumours- 20,292 (of these 1,921 for a melanoma), 6,508 for colorectal tumours, 5,241 for breast tumours, 1,024 for tumours of the upper digestive tract (oesophagus 161, stomach 863), 971 for hepatopancreaticobiliary tumours (liver 103, gallbladder and biliary tract 363 and pancreas 505), 926 for lung tumours, 831 for thyroid gland tumours, 219 for connective tissue tumours and 1,305 for other tumours not included in any of the above-mentioned categories. The average five-year survival differs significantly based on the organ localisation and disease stage. Oncosurgical surgeries are performed in various degrees at practically all surgical in-patient departments in the CR; there are currently 157 in total. The frequency of surgeries for individual diagnoses at most of the departments is not in accordance with the principle of high-volume hospitals, which is based on the assumption that with the increasing number of surgeries the results tend to improve. Based on an analysis of the treatment results recorded in the NOR, differences in the survival rate are dependent on the number of surgeries performed in the given department. Specialisation training in oncosurgery was introduced in 2011 in the CR where a new additional specialisation in oncosurgery was integrated into surgical specialisation training; 60 surgeons had completed this specialisation by spring 2013.
Conclusion: The analysis of the current situation in the surgical treatment of solid malignant tumours in the Czech Republic shows a large participation of surgeons in the treatment of these patients, as well as significant representation of digestive tumours, the diagnosis and treatment of which surgeons perform in close co-operation with gastroenterologists. Out of 51,796 primarily diagnosed solid malignant tumours, the treatment of which falls within the competence of surgeons, 27% are tumours of the gastrointestinal tract. Analysis of the current situation brings forth a recommendation fora rational concentration of oncosurgical surgeries in a smaller number of surgical departments. These departments must ensure the necessary specialisation and organisational conditions, including increasing the qualifications of surgeons by way of additional specialisation in oncosurgery. It is also important to ensure adequate financial funds for complicated and demanding oncosurgical procedures from health insurance companies, which to date has not yet been adequately resolved.
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