OBJECTIVE(S):
The objective of the study is to evaluate the association between NCI cancer center designation and postoperative mortality and long-term survival following colorectal cancer surgery.
METHODS:
We performed a retrospective cohort study of SEER-Medicare database patients undergoing segmental colectomy or proctectomy for cancer from 1996-2003. Multivariate logistic regression, with and without propensity scores, and matched conditional regression were performed to evaluate the relationship between NCI status and postoperative mortality (In-hospital or 30-day death). The log-rank test, Kaplan-Meier curves and Cox regression compared survival between hospital types.
RESULTS:
We evaluated 33,970 colectomy and 8,591 proctectomy patients. Postoperative mortality following colectomy was 6.7% at non-NCI and 3.2% at NCI centers. Mortality following proctectomy was 5.0% and 1.9%, respectively. These differences were significant when adjusted for patient and hospital characteristics (table 1). For both colon and rectal cancer patients, long term mortality was significantly improved following resection at NCI centers (HR .84, p<.001; HR .85, p=.02, respectively) (table 2).
CONCLUSIONS:
NCI designation is associated with lower risk of postoperative death and improved long-term survival. Possible factors responsible for these benefits include surgeon training, multidisciplinary care and adherence to treatment guidelines. Studies are underway to elucidate the factors leading to improved patient outcomes.

Table1: Odds ratios for Postoperative Mortality at an NCI Cancer Center

	Multivariate Model OR (p value)
	Multivariate Logistic Model	Propensity Score Model	Matched Conditional Model
Colon	.59 (.009)	.56 (.008)	.55 (.05)
Rectal	.50 (.05)	.49 (.05)	.51 (.1)

Table 2: Median Survival in Years by Stage

		Non-NCI Center	NCI Center	p-value
Colon Cancer	Stage I	7.0	8.1	.02
	Stage II	5.1	6.8	<.001
	Stage III	3.2	4.7	.001
	Stage IV	0.6	0.8	.09
Rectal Cancer	Stage I	7.4	---	.008
	Stage II	4.7	6.7	.05
	Stage III	3.5	4.3	.08
	Stage IV	1.0	1.4	.09

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