Surgeon is the most important prognostic factor in cancer treatment. Leading Swedish rectal cancer surgeon discusses rectal cancer surgical treatment. “Surgeons must know how to do correct type of operation. Surgical experience is not a substitute for education and knowledge of the best method of treatment”. Cancer surgeon must be able to adjust his surgical technique and match the scope of operation to patient’s condition. Is your cancer surgeon competent and flexible enough to personalize surgical operation for you? Surgery for rectal cancer. Dr. Anton Titov, MD. Who is the best cancer surgeon? Is surgery the best treatment for rectal cancer? Rectal cancer surgery options. Advanced rectal cancer surgery. Medical second opinion confirms that rectal cancer diagnosis is correct and complete. Medical second opinion also confirms that rectal cancer surgery is required. Best treatment for rectal cancer. Dr. Anton Titov, MD. Medical second opinion helps to choose the best treatment for rectal cancer. Get medical second opinion on rectal cancer and be confident that your treatment is the best. Best rectal cancer treatment center and cancer surgeon. Video interview with leading expert in rectal cancer treatment surgery and minimally invasive rectal cancer treatment. Colorectal cancer leading cancer surgeon. Dr. Anton Titov, MD. You authored a very detailed clinical trial. "cancer surgeon as the prognostic factor in rectal cancer treatment". In cancer treatment skill of cancer surgeon is the most important factor for the best prognosis. There are many clinical trials. They determine how the molecular markers and TNM staging impact cancer treatment and prognosis. But leading cancer surgeon quality and skill is the most important prognostic factor in overall survival in cancer. Dr. Anton Titov, MD. Could you please comment on your studies of surgery’s quality? What determines the experience of the cancer surgeon in colorectal cancer treatment? Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). The importance of the skill and quality of the cancer surgeon has been studied extensively. We did a clinical trial in Stockholm. We assessed colorectal cancer surgeons that participated in educational projects. In 1994 we started a project with colorectal cancer surgeon Professor Bill Heald from England. He was teaching colorectal surgeons in Stockholm on how to do a good total mesorectal excision in rectal cancer patients. We had colorectal cancer surgeons who participated in those courses. We also had colorectal cancer surgeons who did not participate in total mesorectal excision surgery training courses. We have a very good rectal cancer registry in Sweden. From rectal cancer registry we could see this rectal cancer surgeons operated on this rectal cancer patients. This was when Dr. Heald was teaching total mesorectal excision rectal cancer surgery in Stockholm. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). So we assessed all patients that had been operated for rectal cancer between 1995 and 1997. We could see this. Rectal cancer patients were operated by colorectal surgeons who participated in the courses. We also saw this patients were operated on by high-volume rectal cancer surgeons. We defined "high-volume" as rectal cancer surgeons doing more than 15 operations per year. So there were two groups: rectal cancer surgeons who participated in courses on total mesorectal excision training and rectal cancer surgeons who did not participate. There were also high-volume rectal caner surgeons and low-volume rectal cancer surgeons. They did fewer than 15 rectal cancer surgeries per year. 50% of all rectal cancer patients had been operated on by high-volume surgeons. These rectal cancer surgeons attended total mesorectal excision training courses. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). High-volume rectal cancer surgeons attended TME training. They had significantly better results than surgeons who had been to the courses but who did less than 15 rectal cancer surgeries per year. The worst results of surgical treatment of rectal cancer was by those colorectal surgeons who did not attend the total mesorectal excision training course. They had low-volume surgical practice for rectal cancer. Dr. Anton Titov, MD. These rectal cancer surgery quality results correlate with surgery quality clinical trials in other specialities. Your clinical trial also showed that 2 or 3 rectal cancer surgeons had the highest number of rectal cancer surgery cases. They had the best results among all rectal cancer surgeons in the registry. Dr. Torbjorn Holm, MD (Rectal Cancer surgeon, Professor, Karolinska Institute, Stockholm). Yes, exactly. We were five rectal cancer surgeons in Stockholm doing more than 15 operations per year. We have significantly better rectal cancer surgery results than surgeons doing fewer operations. We also have better results than surgeons who did not attend special training on TME rectal cancer surgery. So it's very important, as I said before. You have to have the correct education. You have to have the numbers. You must do many surgical operations of the type that's required. You have to combine both. Sometimes you don't have the correct education and do a lot of surgeries. It does not matter. You need both education and the skill. You must do a large number of surgical operations to obtain the best results in rectal cancer surgical treatment. Dr. Anton Titov, MD. Surgery for rectal cancer. What skills must cancer surgeon have? How to choose best cancer surgeon for rectal cancer treatment? Video interview with leading Swedish cancer surgeon.