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Cai Z, Song H, Huang Z, Fingerhut A, Xu X, Zhong H, Li Z, Zhang Y, Sha D, Bao D, Wang H, Cai B, Hua S, Zhang Y, Sun J, Ye K, Li J, Lu Y, Feng B. Safety and feasibility of laparoscopic surgery for colorectal and gastric cancer under the Chinese multi-site practice policy: admittance standards of competence are needed. Gastroenterol Rep (Oxf) 2022; 10:goac046. [PMID: 36196254 PMCID: PMC9522381 DOI: 10.1093/gastro/goac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background The multi-site practice (MSP) policy has been practiced in China over 10 years. This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer (LSCRC) and gastric cancer (LSGC) under the Chinese MSP policy. Methods We collected and analysed the data from 1,081 patients who underwent LSCRC or LSGC performed by one gastrointestinal surgeon in his original hospital (n = 573) and his MSP institutions (n = 508) between January 2017 and December 2020. Baseline demographics, intraoperative outcomes, post-operative recovery, and pathological results were compared between the original hospital and MSP institutions, as well as between MSP institutions with and without specific competence (surgical skill, operative instrument, perioperative multi-discipline team). Results In our study, 690 patients underwent LSCRC and 391 patients underwent LSGC. The prevalence of post-operative complications was comparable for LSCRC (11.5% vs 11.1%, P = 0.89) or LSGC (15.2% vs 12.6%, P = 0.46) between the original hospital and MSP institutions. However, patients in MSP institutions without qualified surgical assistant(s) and adequate instruments experienced longer operative time and greater intraoperative blood loss. The proportion of patients with inadequate lymph-node yield was significantly higher in MSP institutions than in the original hospital for both LSCRC (11.5% vs 21.2%, P < 0.01) and LSGC (9.8% vs 20.5%, P < 0.01). Conclusion For an experienced gastrointestinal surgeon, performing LSCRC and LSGC outside his original hospital under the MSP policy is safe and feasible, but relies on the precondition that the MSP institutions are equipped with qualified surgical skills, adequate operative instruments, and complete perioperative management.
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Affiliation(s)
| | | | | | - Abraham Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Ximo Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Hao Zhong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Zhigang Li
- Department of General Surgery, Wuxi Huishan District People’s Hospital, Jiangsu, P. R. China
| | - Yingjie Zhang
- Department of General Surgery, Zhoushan Hospital, Zhejiang, P. R. China
| | - Dachong Sha
- Department of General Surgery, Cixi Third People’s Hospital, Zhejiang, P. R. China
| | - Dandan Bao
- Department of General Surgery, People’s Hospital of Wenzhou, Zhejiang, P. R. China
| | - Haibo Wang
- Department of General Surgery, Chinese PLA 107 Hospital, Shandong, P. R. China
| | - Binghua Cai
- Department of General Surgery, Rudong People’s Hospital, Jiangsu, P. R. China
| | - Shangbo Hua
- Department of General Surgery, Kunshan Hospital of Chinese Medicine, Jiangsu, P. R. China
| | - Yanhui Zhang
- Department of General Surgery, Jingjiang Chinese Medicine Hospital, Jiangsu, P. R. China
| | - Jianguang Sun
- Department of General Surgery, Haiyan People’s Hospital, Zhejiang, P. R. China
| | - Ke Ye
- Department of General Surgery, Yueqing People’s Hospital, Zhejiang, P. R. China
| | - Jianwen Li
- Corresponding author. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64370045; ; Department of Medical Affairs, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China; Tel: +86-21-64370045; ; Shanghai Minimally Invasive Surgery Center, No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64458887;
| | - Yong Lu
- Corresponding author. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64370045; ; Department of Medical Affairs, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China; Tel: +86-21-64370045; ; Shanghai Minimally Invasive Surgery Center, No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64458887;
| | - Bo Feng
- Corresponding author. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64370045; ; Department of Medical Affairs, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China; Tel: +86-21-64370045; ; Shanghai Minimally Invasive Surgery Center, No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64458887;
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Trosman JR, Carlos RC, Simon MA, Madden DL, Gradishar WJ, Benson AB, Rapkin BD, Weiss ES, Gareen IF, Wagner LI, Khan SA, Bunce MM, Small A, Weldon CB. Care for a Patient With Cancer As a Project: Management of Complex Task Interdependence in Cancer Care Delivery. J Oncol Pract 2016; 12:1101-1113. [PMID: 27577619 DOI: 10.1200/jop.2016.013573] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cancer care is highly complex and suffers from fragmentation and lack of coordination across provider specialties and clinical domains. As a result, patients often find that they must coordinate care on their own. Coordinated delivery teams may address these challenges and improve quality of cancer care. Task interdependence is a core principle of rigorous teamwork and is essential to addressing the complexity of cancer care, which is highly interdependent across specialties and modalities. We examined challenges faced by a patient with early-stage breast cancer that resulted from difficulties in understanding and managing task interdependence across clinical domains involved in this patient's care. We used team science supported by the project management discipline to discuss how various task interdependence aspects can be recognized, deliberately designed, and systematically managed to prevent care breakdowns. This case highlights how effective task interdependence management facilitated by project management methods could markedly improve the course of a patient's care. This work informs efforts of cancer centers and practices to redesign cancer care delivery through innovative, practical, and patient-centered approaches to management of task interdependence in cancer care. Future patient-reported outcomes research will help to determine optimal ways to engage patients, including those who are medically underserved, in managing task interdependence in their own care.
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Affiliation(s)
- Julia R Trosman
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Ruth C Carlos
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Melissa A Simon
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Debra L Madden
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - William J Gradishar
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Al B Benson
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Bruce D Rapkin
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Elisa S Weiss
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Ilana F Gareen
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Lynne I Wagner
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Seema A Khan
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Mikele M Bunce
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Art Small
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Christine B Weldon
- Center for Business Models in Healthcare; Northwestern University, Chicago, IL; University of Michigan Health System; University of Michigan Medical School, Ann Arbor, MI; ECOG/ACRIN Cancer Research Group, Philadelphia, PA; National Breast Cancer Coalition, Washington, DC; Genentech, South San Francisco, CA; Albert Einstein Cancer Center; Albert Einstein College of Medicine, Bronx; The Leukemia & Lymphoma Society, Rye Brook, NY; Brown University School of Public Health, Providence, RI; Wake Forest University School of Medicine; and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
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