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Surgery for Rectal Cancer Performed At Teaching Hospitals Improves Long-Term Survival
Juan C. Gutierrez*1, Leonidas G. Koniaris1, Dido Franceschi1, Rabih M. Salloum2
1DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL; 2Department of Surgery, University of Rochester Medical Center, Rochester, NY

Introduction: To define the long-term outcomes at teaching and community-based hospitals for surgically treated adenocarcinoma of the rectum.
Methods: All rectal adenocarcinomas undergoing surgical resection from the Florida Cancer Data System from 1994 to 2000 were examined.
Results: Overall, 5925 operative cases of rectal adenocarcinoma were identified. Teaching hospitals treated 12.5% of patients, with a larger proportion of stage III and IV disease (65.4% vs. 62.9%) and high-grade tumors (16.1% vs. 15.2%). Five and 10-year overall survival rates at teaching hospitals were 64.8% and 53.9%, compared to 59.1% and 50.5% (P = 0.002). The greatest impact on survival was observed for the highest stage and highest grade tumors. Patients with metastatic disease experienced five 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). Patients with high grade tumors experienced five and 10-year survival rates of 61.3% and 52.5% at teaching hospitals compared to 46.5% and 40.5% survival rates at community hospitals (P = 0.007). Multi-modality therapy was most frequently administered in the teaching hospital setting, where 58.1% of patients received radiotherapy and 60.8% received chemotherapy (vs. 27.1% and 22.1% at community hospitals). Teaching hospitals were associated with a higher utilization of neoadjuvant therapy and of sphincter preserving surgery. On multivariate analysis, treatment at a teaching hospital was a significant independent predictor of improved survival (hazard ratio = 0.870, P = 0.032). Age over 60 years, male gender and advanced stage were each independent predictors of death. Radiotherapy and a low anterior resection compared to abdominoperineal resection were both significant predictors of improved survival in multivariate analysis.
Conclusions: Rectal cancer patients treated at teaching hospitals have significantly better survival than those treated at community-based hospitals. Patients with advanced disease, low lesions or high-grade tumors should be provided the opportunity to be treated at a teaching hospital.

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