
==== Front
Ann Surg Oncol
Ann Surg Oncol
Annals of Surgical Oncology
1068-9265
1534-4681
Springer International Publishing Cham

38806762
15519
10.1245/s10434-024-15519-y
ASO Author Reflections
ASO Author Reflections: Practice Patterns and Outcomes Among Surgical Oncology Fellowship Graduates Performing Complex Cancer Surgery in the United States Across Different Career Stages
Tsilimigras Diamantis I. MD, PhD
http://orcid.org/0000-0002-7994-9870
Pawlik Timothy M. MD, PhD, MPH, MTS, MBA tim.pawlik@osumc.edu

https://ror.org/00c01js51 grid.412332.5 0000 0001 1545 0811 Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH USA
28 5 2024
28 5 2024
2024
31 10 69706971
2 5 2024
8 5 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by/4.0/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
issue-copyright-statement© Society of Surgical Oncology 2024
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pmcPast

Surgical oncology fellowships were developed to help equip surgeons with the necessary skill set for independent practice in a field that involves technically challenging cancer operations.1,2 To date, none of the available administrative datasets includes information on fellowship training, year of graduation, and years of independent practice for surgical oncologists in practice. In turn, there is a lack of information regarding practice patterns and outcomes of newly graduated surgical oncologists compared with more experienced surgeons. As such, we sought to examine perioperative mortality and serious complications among Medicare beneficiaries undergoing complex cancer surgery by surgical oncology fellowship graduates across different career stages in the United States.3

Present

Between 2016 and 2021, a total of 11,746 Medicare beneficiaries underwent complex cancer surgery (pancreatectomy: 61.2%; hepatectomy: 19.5%; rectal resection: 13.7%; esophagectomy: 5.6%) by 676 fellowship-trained surgical oncologists in the United States. Through manual screening of each individual surgeon record, we identified surgeons who had formally completed a surgical oncology fellowship in the United States and categorized them into three groups according to years of individual practice; early career (1–7 years, n = 375, 55.%); mid-career (8–14 years, n = 155, 22.9%), and late career (≥15 years, n = 146, 21.6%). Patients who were operated on by early career surgeons less frequently had surgery in a metropolitan area (79.8% vs. 82.7%) while more frequently were treated at a Midwestern (24.9% vs. 14.2%) rather than Northeastern institution (20.6% vs. 26.9%) compared with individuals treated by late career surgeons (all p < 0.05). After adjusting for patient, procedural, hospital, and surgeon-level factors, surgical oncologists had comparable risk-adjusted serious complications and 90-day mortality rates irrespective of career stage (early career: 13.0% and 7.2%; mid-career: 12.6% and 6.3%; late career: 12.8% and 6.5%, respectively, all p > 0.05). Surgical oncologists who completed a fellowship at a currently ACGME-accredited program had comparable outcomes with surgeons who graduated from nonaccredited programs (serious complications: odds ratio [OR] 0.94, 95% confidence interval [CI] 0.74–1.19; 90-day mortality: OR 1.39, 95% CI 0.97–1.98). Female surgical oncologists represented only 17.7% of all surgeons; yet, the odds of serious complications and 90-day mortality were comparable among male and female surgical oncologists across all career stages. Surgeon case-specific volume independently predicted serious complications not only among early career but also among middle and late career surgical oncologists (high vs. low volume; early career: OR 0.80, 95% CI 0.65–0.98; mid-career: OR 0.81, 95% CI 0.66–0.99; late career: OR 0.78, 95% CI 0.62–0.97).

Future

The incidence of serious complications and 90-day mortality was comparable among early versus middle/late career surgical oncologists performing complex cancer surgery in the United States. Although male and female surgical oncologists had similar outcomes, female surgeons performing complex cancer surgery were largely underrepresented, underscoring the importance of ongoing diversification in the field of surgical oncology. Individual surgeon volume rather than years of independent practice largely determined perioperative outcomes, highlighting the need to maintain surgical volume even among senior surgical oncologists to ensure delivery of high-quality care to cancer patients.

Disclosures

The authors have no conflicts of interest to disclose.

This article refers to: Tsilimigras DI, Chatzipanagiotou O, Woldesenbet S, et al. Practice Patterns and Outcomes Among Surgical Oncology Fellowship Graduates Performing Complex Cancer Surgery in the United States Across Different Career Stages. Annals Surgical Oncology. (2024).10.1245/s10434-024-15436-0.

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3. Tsilimigras DI Chatzipanagiotou O Woldesenbet S Practice patterns and outcomes among surgical oncology fellowship graduates performing complex cancer surgery in the United States across different career stages Ann Surg Oncol. 2024 10.1245/s10434-024-15436-0 39251514
Tsilimigras DI, Chatzipanagiotou O, Woldesenbet S, et al. Practice patterns and outcomes among surgical oncology fellowship graduates performing complex cancer surgery in the United States across different career stages. Ann Surg Oncol. 2024. 10.1245/s10434-024-15436-0.39251514
