title: Variation in primary site resection practices for advanced colon cancer: a study using the National Cancer Data Base.
abstract: BACKGROUND
  Treatment of metastatic colon cancer may be driven as much by practice patterns as by features of disease. To optimize management, there is a need to better understand what is determining primary site resection use.
  
  
  METHODS
  We evaluated all patients with stage IV cancers in the National Cancer Data Base from 2002 to 2012 (50,791 patients, 1,230 hospitals). We first identified patient characteristics associated with primary tumor resection. Then, we assessed nationwide variation in hospital resection rates.
  
  
  RESULTS
  Overall, 27,387 (53.9%) patients underwent primary site resection. Factors associated with resection included younger age, having less than 2 major comorbidities, and white race (P < .001). Nationwide, hospital-adjusted primary tumor resection rates ranged from 26.0% to 87.8% with broad differences across geographical areas and hospital accreditation types.
  
  
  CONCLUSIONS
  There is statistically significant variation in hospital rates of primary site resection. This demonstrates inconsistent adherence to guidelines in the presence of conflicting evidence regarding resection benefit.
authors: Department of Surgery, University of Michigan Health System, Center for Healthcare Outcomes and Policy, 2800 Plymouth Road, Building 16, 016-100N28, Ann Arbor, MI 48109, USA. Electronic address: healym@umich.edu.
authors: Mark A
authors: MA
authors: Healy
authors: University of Michigan Medical School, Ann Arbor, MI, USA.
authors: Jason C
authors: JC
authors: Pradarelli
authors: Department of Surgery, University of Michigan Health System, Center for Healthcare Outcomes and Policy, 2800 Plymouth Road, Building 16, 016-100N28, Ann Arbor, MI 48109, USA.
authors: Robert W
authors: RW
authors: Krell
authors: Department of Surgery, University of Michigan Health System, Center for Healthcare Outcomes and Policy, 2800 Plymouth Road, Building 16, 016-100N28, Ann Arbor, MI 48109, USA.
authors: Scott E
authors: SE
authors: Regenbogen
authors: Department of Surgery, University of Michigan Health System, Center for Healthcare Outcomes and Policy, 2800 Plymouth Road, Building 16, 016-100N28, Ann Arbor, MI 48109, USA.
authors: Pasithorn A
authors: PA
authors: Suwanabol
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D000066491:Clinical Decision-Making; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data; D018714:Radiotherapy, Adjuvant; D014481:United States / Q000453:epidemiology
keywords: Clinical decision making; Colon neoplasms; Colon surgery; Hospitals; Neoplasm metastasis