Referral patterns for locoregional recurrent colon cancer and impact of tertiary care on outcomes

Background Locoregional recurrence (LRR) after segmental colectomy occurs in 4–12% of patients and can present uni- or multifocal at the site of the primary tumor or on the peritoneal surface. Apart from intentional curative treatment of peritoneal recurrence, care for LRR is not centralized in the Netherlands. This study aimed to evaluate referral patterns for LRR and compared oncological outcomes between tertiary and nontertiary hospitals. Methods This retrospective cross-sectional cohort study across 50 Dutch hospitals included patients who underwent curative resection of colon cancer in 2014 and 2015 and subsequently developed LRR. Predictors of referral to tertiary care were identified using a multivariable regression. Median overall survival (OS) and 3-year re-LRR incidence were compared between tertiary and nontertiary hospitals. Results A total of 658 patients with LRR were included and 193 (29.3%) were treated with curative intent, of whom 123 (63.7%) were treated at a tertiary center. Independent predictors for referral were peritoneal localization of LRR (odds ratio (OR) 15.9, 95% confidence interval (CI) 7.11–38.9) and age (≥ 70 years OR 0.27, 95% CI 0.11–0.63). Curative intent treatment at tertiary or nontertiary centers showed no significant differences in median OS (37.7 versus 45.0 months, p = 0.944), or 3-year re-LRR (51.8% versus 40.2%, p = 0.274). In the palliative setting, whether patients were discussed at a multidisciplinary team was associated with longer OS (9.6 versus 4.7 months, p < 0.001). Conclusion Referral to tertiary centers was predominantly determined by peritoneal localization of recurrence, reflecting the current organization of care in the Netherlands. Following referral, no significant differences in OS or re-recurrence were observed between tertiary and nontertiary hospitals after curative-intent treatment.