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National Cancer Institute Designation Predicts Improved Outcomes in Colorectal Cancer Surgery

Paulson, Emily Carter MD*; Mitra, Nandita PhD; Sonnad, Seema PhD*; Armstrong, Katrina MD, MSCE; Wirtalla, Christopher BA*; Kelz, Rachel Rapaport MD, MSCE§; Mahmoud, Najjia N. MD

doi: 10.1097/SLA.0b013e318187a757
Original Articles

Background: Although National Cancer Institute (NCI) designation as a cancer center is based almost solely on research activities, it is often viewed, by patients and referring providers, as an indication of clinical excellence.

Objective: To compare the short- and long-term outcomes of colon and rectal cancer surgery performed at NCI-designated centers to the outcomes after resection at non–NCI-designated hospitals.

Methods: We performed a retrospective cohort study of Survival, Epidemiology, and End Results (SEER)-Medicare database patients undergoing segmental colectomy (n = 33,969) or proctectomy (n = 8591) 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 33,969 colectomy and 8591 proctectomy patients. Postoperative mortality after colectomy was 6.7% at non-NCI and 3.2% at NCI centers. Mortality after proctectomy was 5.0% and 1.9%, respectively. These differences were significant when adjusted for patient and hospital characteristics. For both colon and rectal cancer patients, long-term mortality was significantly improved after resection at NCI centers (HR 0.84, P < 0.001; HR 0.85, P = 0.02, respectively).

Conclusion: 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.

We used the Survival, Epidemiology, and End Results-Medicare database to examine outcomes of colorectal cancer surgery at National Cancer Institute-designated cancer centers. Postoperative mortality was significantly lower after resection at National Cancer Institute-designated centers compared with non–National Cancer Institute-designated centers adjusting for patient and hospital characteristics. Similarly, improved long-term survival was associated with National Cancer Institute designation.

From the *Department of Surgery, Hospital of the University of Pennsylvania; †School of Medicine, University of Pennsylvania; and ‡Department of General Internal Medicine, Divisions of §Endocrine and Oncologic Surgery and ¶Colon and Rectal Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.

Reprints: Najjia N. Mahmoud, MD, Department of Surgery, 4 Silverstein Pavilion, Philadelphia, PA 19104. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.