June's Paper of the Month looks at a cohort study to assess the effect of surgeon sex on short- and long-term outcomes after colon cancer resections.

Short- and long-term outcome after colon cancer resections performed by male and female surgeons: A single-center retrospective cohort study
Engdahl J, Öberg A, Bech-Larsen S, Bergenfeldt H, Vedin T, Edelhamre M, Öberg S. Scand J Surg. 2024 Feb 18:14574969241228510. doi: 10.1177/14574969241228510. Online ahead of print.

In the study conducted by Engdahl et al, the authors employed a well-validated, high-quality national registry to identify 1113 patients undergoing resection surgery for colon cancer, supplemented by additional medical chart review. After adjusting for various confounders such as patient sex, ASA score, cancer stage, surgical volume, experience, approach as well as on-call surgery and indication in emergent cases, the authors concluded that there was no difference in short- or long-term outcomes following elective resections between male and female surgeons. However, in emergent cases, female surgeons produced less complications, re-operations, and achieved better long-term survival. Notably, fewer R1 resections and admissions to the ICU were observed after surgery performed by a woman.

Scientific articles on aspects of surgical outcomes in relation to surgeon sex often attract a great deal of attention and public interest, unlike many other surgical studies. Recent examples include findings from a population-based study in Canada, which demonstrated lower healthcare costs at 30-day, 90-day, and 1-year intervals for patients operated on by female surgeons compared to those operated on by male surgeons across 25 common elective or emergent surgical procedures 2. Additionally, a study based on data from the Swedish Gallriks quality registry, focusing on cholecystectomies, found that female surgeons tended to perform operations at a slower pace but with fewer complications 3. Given the interest generated by these trials, it is imperative that such research is meticulously conducted with a keen awareness of methodological limitations. A thorough understanding is essential for genuinely improving surgical practices for all patients.

Colorectal surgeons exhibit distinct personality traits compared to the general population, with certain traits influencing decision-making in specific scenarios 4. Work environment and how we communicate may also impact surgical outcomes 5. More research is needed on personality, risk taking and decision making in surgery. It is important to determine whether these factors are the main drivers of the observed differences in outcomes. It remains to be seen whether sex is then still a driver of the observed differences in outcomes.

It is evident that contemporary surgical procedures necessitate a collaborative approach. While it is not possible to alter one's biological sex, it is possible to modify one's behavioural patterns.

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