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Metastasectomy for Stage IVA Colon Cancer: Does the Type of Treating Institution Make a Difference?

Authors
  • Kang, Shinho T1
  • Moran, Ryan2
  • Hussain, Lala3
  • Guend, Hamza4
  • Dunki-Jacobs, Erik M5
  • Lee, David Y6
  • 1 Good Samaritan Hospital General Surgery Residency Program, TriHealth, Cincinnati, OH, USA.
  • 2 12303University of Cincinnati College of Medicine, Cincinnati, OH, USA.
  • 3 Department of Biostatistics, TriHealth Hatton Research Institute, Cincinnati, OH, USA.
  • 4 Division of Colorectal Surgery, TriHealth Surgical Institute, Cincinnati, OH, USA.
  • 5 Division of Surgical Oncology, TriHealth Cancer Institute, Cincinnati, OH, USA.
  • 6 Division of Surgical Oncology, Schar Cancer Institute, Inova Health System, Fairfax, VA, USA.
Type
Published Article
Journal
The American surgeon
Publication Date
Aug 01, 2022
Volume
88
Issue
8
Pages
1976–1982
Identifiers
DOI: 10.1177/00031348211023389
PMID: 34077694
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Treatment of metastatic colon cancer has evolved over time. More evidence has been emerging in recent years supporting metastasectomy in selected patients. We sought to elucidate whether the type of institution-community, comprehensive community, academic/research, and integrated cancer network-would have an effect on patient outcome, specifically those colon cancer patients with isolated liver metastasis. This retrospective cohort study queried the National Cancer Database (NCDB) from 2010 to 2014 for patients who were 18 years of age or older with stage IVA colon cancer with isolated liver metastasis. We then performed uni- and multivariate analyses comparing patients based on such factors as age, tumor characteristics, primary tumor location, rate of chemotherapy, and type of treating institution. Patients who came from regions of higher income, receiving chemotherapy, and presenting to an academic/research hospital were more likely to undergo metastasectomy. Median survival was longest at academic/community hospitals at 22.4 months, 6 to 7 months longer than the other three types of institutions. Factors positively affecting survival included receiving chemotherapy, presenting to an academic/research institution, and undergoing metastasectomy, all at P < .05. In our study, the rate of metastasectomy was more than double at academic/research institutions for those with stage IVA colon cancer with isolated liver metastasis. Prior studies have quoted a mere 4.1% synchronous colon resection and metastasectomy. Our findings suggest that we should maintain multidisciplinary approach to this complex disease process and that perhaps it is time for us to consider regionalization of care in treating metastatic colon cancer.

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