Dual Surgeon Operating to Prevent Colorectal Cancer Surgery Skill Fatigue in Rural Surgery-A Prospective Audit of 154 Patients

Abstract

Background: Skill maintenance for rural surgeons is challenging. Surgery for colorectal disease requires a specialised skill set. Dual surgeon operating in low or medium volume centres may mitigate skill fade and improve surgical outcomes. There is a paucity of data on the outcomes of dual surgeon operating.

Methods: Prospective audit of outcomes after dual surgeon operations for colorectal disease in a non-metropolitan surgical centre. Results are compared with treatment outcomes in the same hospital prior to the dual surgeon approach. Ethics approval CALHN Human Research Ethics Committee (Ref # 12041).

Results: One hundred fifty-four patients underwent surgery for colorectal cancer during the audit period (November 2015 to February 2025). 60% of the patients were male (N = 92); median age was 70 years. Compared to the historic control (N = 233) there was a significant reduction in wound infections (3.2% vs. 12.4%, p = 0.0038), complications (24% vs. 40%, p = 0.02), intraoperative blood loss (60 vs. 250 mL, p < 0.001) and length of stay (6 vs. 8 days, p < 0.001). The lymph node yield was significantly increased (17 vs. 13, p < 0.001). Significantly more patients underwent laparoscopic colorectal surgery (87% vs. 23.6%, intention to treat, p < 0.00001) with a reduction of conversions (6% vs. 11%, p = 0.28). Outcomes were improved but did not reach statistical significance with regard to 30-day mortality (0.64% vs. 0.86%, p = 0.82), leak rate (2.2% vs. 5.5% of procedures with anastomosis, p = 0.15) and unplanned return to theatre (4.6% vs. 7.7%, p = 0.24).

Conclusions: Our findings confirm that two-surgeon operating is feasible and safe for the treatment of colorectal cancer. Significantly better postoperative outcomes can be achieved with regard to complications, blood loss, and length of stay. The approach allows for more than 85% of all procedures to be done minimally invasive. Dual-surgeon operating helps to mitigate skill fade as well as loss of confidence for surgeons performing complex colorectal procedures in a low/medium volume setting.

Keywords: audit; colorectal cancer; dual surgeon operating; laparoscopic surgery; non‐metropolitan; rural; two surgeon approach.