Patterns of Care and Outcomes of Rectal Cancer Patients from the Iowa Cancer Registry: Role of Hospital Volume and Tumor Location.

Autor: Goffredo P; Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, MN, USA., Hart AA; Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA., Tran CG; Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA., Kahl AR; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.; Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, IA, USA., Gao X; Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA., Del Vecchio NJ; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA., Charlton ME; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.; Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, IA, USA., Hassan I; Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA. Imran-hassan@uiowa.edu.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2023 Jun; Vol. 27 (6), pp. 1228-1237. Date of Electronic Publication: 2023 Mar 22.
DOI: 10.1007/s11605-023-05656-2
Abstrakt: Background: Centralization of rectal cancer surgery has been associated with high-quality oncologic care. However, several patient, disease and system-related factors can impact where patients receive care. We hypothesized that patients with low rectal tumors would undergo treatment at high-volume centers and would be more likely to receive guideline-based multidisciplinary treatment.
Methods: Adults who underwent proctectomy for stage II/III rectal cancer were included from the Iowa Cancer Registry and supplemented with tumor location data. Multinomial logistic regression was employed to analyze factors associated with receiving care in high-volume hospital, while logistic regression for those associated with ≥ 12 lymph node yield, pre-operative chemoradiation and sphincter-preserving surgery.
Results: Of 414 patients, 38%, 39%, and 22% had low, mid, and high rectal cancers, respectively. Thirty-two percent were > 65 years, 38% female, and 68% had stage III tumors. Older age and rural residence, but not tumor location, were associated with surgical treatment in low-volume hospitals. Higher tumor location, high-volume, and NCI-designated hospitals had higher nodal yield (≥ 12). Hospital-volume was not associated with neoadjuvant chemoradiation rates or circumferential resection margin status. Sphincter-sparing surgery was independently associated with high tumor location, female sex, and stage III cancer, but not hospital volume.
Conclusions: Low tumor location was not associated with care in high-volume hospitals. High-volume and NCI-designated hospitals had higher nodal yields, but not significantly higher neoadjuvant chemoradiation, negative circumferential margin, or sphincter preservation rates. Therefore, providing educational/quality improvement support in lower volume centers may be more pragmatic than attempting to centralize rectal cancer care among high-volume centers.
(© 2023. The Society for Surgery of the Alimentary Tract.)
Databáze: MEDLINE
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