Surgery for rectal cancer performed at teaching hospitals improves survival and preserves continence.
We sought to compare the outcomes of teaching and community hospitals on long-term outcomes for patients with rectal cancer. All rectal adenocarcinomas treated in Florida from 1994 to 2000 were examined. Overall, 5,925 operative cases were identified. Teaching hospitals treated 12.5% of patients with a larger proportion of regionally advanced, metastatic disease, as well as high-grade tumors. Five- and 10-year overall survival rates at teaching hospitals were 64.8 and 53.9%, compared to 59.1 and 50.5% at community hospitals (P = 0.002). The greatest impact on survival was observed for the highest stage tumors: patients with metastatic rectal adenocarcinoma experienced 5- and 10-year survival rates of 30.5 and 26.6% at teaching hospitals compared to 19.6 and 17.4% at community hospitals (P = 0.009). Multimodality therapy was most frequently administered in teaching hospitals as was low anterior resection. On multivariate analysis, treatment at a teaching hospital was a significant independent predictor of improved survival (hazard ratio = 0.834, P = 0.005). Rectal cancer patients treated at teaching hospitals have significantly better survival than those treated at community-based hospitals. Patients with high-grade tumors or advanced disease should be provided the opportunity to be treated at a teaching hospital.
Gutierrez
Juan C
JC
DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 3550 Sylvester Comprehensive Cancer Center (310T), 1475 NW 12th Ave, Miami, FL 33136, USA.
Kassira
Noor
N
Salloum
Rabih M
RM
Franceschi
Dido
D
Koniaris
Leonidas G
LG
D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D000368:Aged; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016019:Survival Analysis