Outcome comparison following colorectal cancer surgery in an equal access system

BackgroundPrevious 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 methodsPatients 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.ResultsA 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.ConclusionOutcomes 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.