title: Assessment of the Surgical Treatment Results in Patients with Colorectal Cancer in a District Hospital Versus Treatment Results in a Highly Specialized Center.
abstract: In Poland there there are about 15-16 thousand cases of colon cancer per year. The health care system allows the treatment of patients with colorectal cancer in highly specialized hospitals, oncology centers and district hospitals. The results of treatment within different reference level differ. The aim of the study was to evaluate the results of surgical treatment of patients with colorectal cancer at a district hospitals compared with the results of highly specialized center.
  
  
  METHODS
  A retrospective study. The material consisted of 171 consecutively operated patients diagnosed with colorectal cancer treated in the Department of Surgery, District Hospital in Wołomin. The control group consisted of 200 patients treated surgically at the Department of General and Colorectal Surgery, University Hospital in Łódź. In both centers, the patients were operated on by surgeons with experience in operations on the large bowel. The demographic data, information on the type of indication (elective vs emergent), and the severity of the disease by AJCC / TNM scale were collected. In the district hospital there were patients with more advanced disease (p <0.001), older (p = 0.0001), and often operated under emergent indication (p = 0.0001). The telephone survey collected data on survival or the date of death of the patient and set the percentage of five-year survival.
  
  
  RESULTS
  The proportion of five-year survival in the study group and control group was respectively 46% and 71% (p <0.0001). The percentage of five-year survival among patients undergoing elective procedure in both centers were respectively for Wołomin and Łódź 58% and 73% (p = 0.008). The proportion of 5-year survival among "younger" patients (<70) was respectively in Wołomin and Łódź 64% and 81% (p = 0.004) for "older" patients with (> 70) 50% and 60% (p = 0.6747) Conclusions. Overall results of surgical treatment of patients with colorectal cancer in the district hospital are inferior to treatment results in a highly specialized center. The population treated in the district hospital is statistically significantly different in comparison to patients treated in highly specialized center. The following differences were captured: severity of the disease, age and type of indication (elective vs emergent). The diffrences has an influence on the outcomes. The five years survival for patients > 70 years undergoing elective procedure is not statistically different between the district hospital and highly specialized center.
authors.forename: Przemysław
authors.initials: P
authors.lastname: Ciesielski
authors.forename: Maciej
authors.initials: M
authors.lastname: Berut
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Górnicki
authors.forename: Jacek
authors.initials: J
authors.lastname: Skoczylas
authors.forename: Maja
authors.initials: M
authors.lastname: Gorajska
authors.forename: Marcin
authors.initials: M
authors.lastname: Żuk
authors.forename: Andrzej
authors.initials: A
authors.lastname: Rutkowski
authors.forename: Justyna
authors.initials: J
authors.lastname: Dłubek
authors.forename: Adam
authors.initials: A
authors.lastname: Dziki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006767:Hospitals, District; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome