Full Citation
Title: Outcome Comparison Following Colorectal Cancer Surgery in an Equal Access System
Citation Type: Journal Article
Publication Year: 2013
ISBN:
ISSN:
DOI:
NSFID:
PMCID:
PMID:
Abstract: Background: Previous reports suggest outcome differences following surgery for colorectal cancer (CRC) based on specialist and volume-related metrics. We sought to compare community and tertiary centers in an equal access system.Materials and methods: Patients treated for CRC at Department of Defense medical facilities were stratified by care at tertiary (MEDCEN) versus community (MEDDAC) medical centers. Disease-free and overall survival outcomes were calculated, including Cox multivariate analysis.Results: A total of 6438 patients met inclusion criteria. Overall, 3347 operations were performed at MEDCENs and 3091 operations at MEDDACs. By stage, 25.6% were stage 1, 27.1% stage 2, 29.1% stage 3, and 18.2% stage 4. Mean number of lymph nodes harvested were 11.3 +/- 10.2, with no difference between facilities. Disease-free survival at 5 y was similar between the two cohorts (mean 88.1%). Overall 5-y survival was 52.7% (MEDDAC) versus 46.8% (MEDCEN), P < 0.001, due to significant differences in stage 2 patients. Cox regression and logistic regression analysis identified stage 2 patients as independently associated with significantly increased 5-y mortality risk at MEDCEN.Conclusion: Outcomes following surgery for CRC in an equal access system are improved in stage 2 patients treated at MEDDACs compared to high-volume, specialist-centered MEDCENs. Further evaluation into factors impacting improved overall survival at MEDDACs, including adjuvant therapy utilization, is warranted to optimize outcomes. Published by Elsevier Inc.
User Submitted?: No
Authors: Steele, Scott R.; Maykel, Justin A.; Causey, Marlin W.; Johnson, Eric K.; DeBarros, Mia
Periodical (Full): Journal of Surgical Research
Issue: 1
Volume: 184
Pages: 507-513
Data Collections: IPUMS USA
Topics: Health, Methodology and Data Collection
Countries: