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- Title
Comparison of survival of stage I–III colon cancer by travel distance and hospital volume.
- Authors
Turner, M. C.; Jawitz, O.; Adam, M. A.; Srinivasan, E.; Niedzwiecki, D.; Migaly, J.; Fisher, D. A.; Mantyh, C. R.
- Abstract
Background: Previous studies have demonstrated improved outcomes at high-volume colorectal surgery centers; however, the benefit for patients who live far from such centers has not been assessed relative to local, low-volume facilities. Methods: The 2010–2015 National Cancer Database (NCDB) was queried for patients with stage I–III colon adenocarcinoma undergoing treatment at a single center. A 'local, low-volume' cohort was constructed of 12,768 patients in the bottom quartile of travel distance at the bottom quartile of institution surgical volume and a 'travel, high-volume' cohort of 11,349 patients in the top quartile of travel distance at the top quartile of institution surgical volume. Results: In unadjusted analysis, patients in the travel cohort had improved rates of positive resection margins (3.7% vs. 5.5%, p < 0.001), adequate lymph-node harvests (92% vs. 83.6%, p < 0.001), and 30- (2.2% vs. 3.9%, p < 0.001) and 90-day mortality (3.7% vs. 6.4%, p < 0.001). On multivariable logistic regression analysis adjusting for patient demographic, tumor, and facility characteristics, the cohorts demonstrated equivalent overall survival (HR: 0.972, p = 0.39), with improved secondary outcomes in the 'travel' cohort of adequate lymph-node harvesting (OR: 0.57, p < 0.001), and 30- (OR 0.79, p = 0.019) and 90-day mortality (OR 0.80, p = 0.004). Conclusions: For patients with stage I–III colon cancer, traveling to high-volume institutions compared to local, low-volume centers does not convey an overall survival benefit. However, given advantages including 30- and 90-day mortality and adequate lymph-node harvest, nuanced patient recommendations should consider both these differences and the unquantified benefits to local care, including cost, travel time, and support systems.
- Subjects
COLON cancer; LOGISTIC regression analysis; PROCTOLOGY; COLON (Anatomy); TRAVEL; RIGHT hemicolectomy
- Publication
Techniques in Coloproctology, 2020, Vol 24, Issue 7, p703
- ISSN
1123-6337
- Publication type
Article
- DOI
10.1007/s10151-020-02207-8