Comment on: Surgeon age in relation to patients’ long-term survival after gastrectomy for gastric adenocarcinoma: nationwide population-based cohort study

We commend the authors for their insightful study utilizing data from the Sweden Nationwide Registry, suggesting surgeons aged over 47 years old may experience poorer long-term outcomes postgastrectomy for gastric cancer¹. Their diligent investigation sheds light on an under-analysed aspect of surgical outcomes and prompts valuable discussions within the medical community. However, upon closer examination, some critical points come to light.

In such retrospective studies, unmeasured or uncontrolled confounding and selection biases can cause concerns with the validity of the results. A primary concern lies in the predominance of low-volume surgeons and hospitals in the study cohort. Indeed, about half of surgeons in the cohort performed less than five gastrectomies a year. It is widely recognized that high-volume surgeons and centres tend to achieve superior outcomes for complex procedures like gastrectomy.

Furthermore, the results are additionally not generalizable to several Asian or Western regions where the volumes are markedly different. In Sweden, 1647 patients underwent gastrectomy with curative intent over 10 years. This figure is several fold lower compared with the high-volume Western centre within the same timeframe, or numerous Asian centres performing over 1000 gastrectomies annually.

Moreover, surgical outcomes are influenced by cumulative experience and skill acquisition, factors that may not be fully captured in the analysis. Age is just a number.

In conclusion, while Leijonmarck et al.'s study initiates crucial discussions regarding surgeon age and long-term cancer outcomes, its findings are circumscribed by the study design. Future investigations should prioritize high-volume surgeons and centres to refine our understanding of the complex relationship between surgeons’ age, skills and experiences.

Author contributions

André Dias (Conceptualization, Writing—original draft), Syed Zafar (Writing—review & editing) and Daniel José Szor (Writing—review & editing)

Reference