Comparison of survival of stage I-III colon cancer by travel distance and hospital volume.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Turner, MC; Jawitz, O; Adam, MA; Srinivasan, E; Niedzwiecki, D; Migaly, J; Fisher, DA; Mantyh, CR

Published Date

  • July 2020

Published In

Volume / Issue

  • 24 / 7

Start / End Page

  • 703 - 710

PubMed ID

  • 32281019

Pubmed Central ID

  • PMC7302993

Electronic International Standard Serial Number (EISSN)

  • 1128-045X

Digital Object Identifier (DOI)

  • 10.1007/s10151-020-02207-8


  • eng

Conference Location

  • Italy