Le chirurgien reste-t-il le facteur pronostique principal ?

Assessment of surgeon's influence on the results of cancer surgery is complex. Investigation field is extremely large and should differentiate surgeon's impact from the one of surgery. This can result in major differences in the rate of postoperative complications and deaths, in the indication and use of technically difficult surgeries, and also in long-term results. The surgeon's impact is correlated with his activity volume for each type of major procedures and is independent from hospital activity volume. It persists independently of major progresses in hospital organization and process standardization. Data from the literature confirm the prognosis importance of the surgeon in cancer outcome. In the future, the timely implementation of established, evidence-based guidelines and checklists programs could prevent large number of deaths and complications and reduce the surgeon specific impact.