Comparison of Colorectal Cancer Recurrence Rate in Patients Undergoing Colectomy in a Cancer Specialized Center Versus a General Hospital

Abstract

Background: Colorectal cancer remains a leading cause of cancer-related morbidity and mortality worldwide. Surgical resection is central to curative treatment, but outcomes vary widely depending on institutional factors, particularly surgical volume. Despite growing global evidence, data comparing recurrence and survival outcomes between high- and low-volume centers in low- and middle-income countries remain limited. Objective: This study aimed to compare colorectal cancer recurrence, distant metastasis, survival, resection margin status, and lymph node yield in patients undergoing colectomy at a high-volume cancer-specialized center versus general tertiary care hospitals. Methods: This was a prospective observational cohort study conducted from April 2023 to April 2024 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar. A total of 350 adult patients (n = 250 in high-volume; n = 100 in low volume) with histologically confirmed colorectal adenocarcinoma or squamous cell carcinoma undergoing colectomy were included. Patients were recruited based on strict inclusion/exclusion criteria and followed for a minimum of 30 days. Outcomes included recurrence, metastasis, survival, lymph node yield, and resection margins. Data were collected prospectively, and all patients received standardized perioperative care. Ethical approval was granted, and informed consent was obtained in accordance with the Declaration of Helsinki. Data analysis was performed using SPSS v27, with appropriate statistical tests and significance set at p < 0.05. Results: Patients treated at the high volume center demonstrated lower recurrence (8% vs. 18%) and metastasis rates (12% vs. 22%), along with a higher three-year survival rate (78% vs. 65%). Negative resection margins were achieved in 96% versus 87%, and the average lymph node yield was higher (18 vs. 12). Major complications (35% vs. 42%) and 30-day mortality (1.5% vs. 2.5%) were also lower in the high-volume group. Conclusion: Colectomy performed at a high-volume cancer-specialized center significantly improves oncologic and postoperative outcomes compared to general hospitals. These findings support regionalization of colorectal cancer surgery and underscore the importance of institutional capacity in achieving optimal clinical care.