It is unclear whether traveling long distances to high-volume centers would compensate for travel burden among patients undergoing rectal cancer resection.
Dr Fergal Fleming and colleagues determined whether operative volume outweighs the advantages of being treated locally by comparing the outcomes of patients with rectal cancer treated at local, low-volume centers versus far, high-volume centers.
The researchers performed a population-based study using The National Cancer Database, and queried for patients with rectal cancer.
Patients with stage II or III rectal cancer who underwent surgical resection between 2006 and 2012 were included.
The team's outcomes of interest were margins, lymph node yield, receipt of neoadjuvant chemoradiation, adjuvant chemotherapy, readmission within 30 days, 30-day and 90-day mortality, and 5-year overall survival.
|The short-distance/low-volume group had a 34% high risk of overall mortality at 5 years |
|Diseases of the Colon & Rectum|
The researchers reported that a total of 18,605 patients met inclusion criteria, of which 2067 patients were in the long-distance/high-volume group, and 1362 in the short-distance/low-volume group.
The median travel distance was 62.6 miles for the long-distance/high-volume group and 2.3 miles for the short-distance/low-volume group.
Patients who were younger, white, privately insured, and stage III were more likely to have traveled to a high-volume center.
When controlled for patient factors, stage, and hospital factors, the team noted that patients in the short-distance/low-volume group had lower odds of a lymph node yield ≥12, and neoadjuvant chemoradiation, and higher 30-day and 90-day mortality compared with those in the long-distance/high-volume group.
The short-distance/low-volume group had a 34% high risk of overall mortality at 5 years compared with the long-distance/high-volume group.
Dr Fleming's team concludes, "Our results indicate that when controlled for patient, tumor, and hospital factors, patients who traveled a long distance to a high-volume center had improved lymph node yield, neoadjuvant chemoradiation receipt, and 30- and 90-day mortality compared with those who traveled a short distance to a low-volume center."
"They also had improved 5-year survival."