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

Abstract 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.

Authors

Institutions

Publication Details

Journal
Techniques in Coloproctology
Published
2026-09-08
DOI
https://doi.org/10.1007/s10151-026-03383-9
Primary Topic
Colorectal Cancer Surgical Treatments
Type
article
Field-Weighted Citation Impact
0.00

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

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

Eva Rademaker, Koen Peeters, Djamila Boerma, A. Demirkiran et al.
Techniques in Coloproctology
Colorectal Cancer Surgical Treatments
article

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

Eva Rademaker, Koen Peeters, Djamila Boerma, A. Demirkiran, Marinke Westerterp, Marjolein M. N. Leeuwenburgh, Wilhelmina M. U. van Grevenstein, Jurriaan B. Tuynman, Johanne G. Bloemen, Joost Rothbarth, V.P. Bastiaenen, O. Kranenburg, C.A. Gispen, Philip R. de Reuver, I. Kappers, Iris Hochstenbach, M Kusters, H. L. van Westreenen, E. Ancion, F. Heilijgers, J. L. M. Konsten, EG Boerma, K. Havenga, J. W. A. Leijtens, H. J. Belgers, D. M. Mens, A.C.H.M. Jongen, T.B.M. Van den Heuvel, S.A. Dingemans, L.A. Brugts, T.A. Burghgraef, D.P.V. Lambrichts, E.Z. Barsom, A.G. Den Hartog, R.J.S. Coelen, R.H.A. Berndsen, R.T.J. Geitenbeek, M.J.P.M. Govaert, E.W. Lockhorst, P. Krielen, M.M. Kieboom, J.D.W. Van der Bilt, B. Lamme, J.W.T. Dekker, J.A.G. Van der Heijden, A. Kumas, N. Koemans, S. Karhof, F.J. Amelung, A.J. Eleveld, S. Dijkink, B.A.J. Kertzman, M. Cleveringa, V.M. Belvroy, M.J.H. Metman, A.A.J. Grüter, H.A. Galema, I. Aanen, H. Lutfi, V.P. Groot, M. A. J. Becker, S. F. Hardon, D. C. Van der Aa, S. Malm, W. H. Kopp, P. Meijer, L. Van Dullemen, S. M. M. De Castro, S. M. Van Aalten, G. L. Van Leeuwen, B. Biersteker, P. Van Amstel, S. Bluiminck, V. Baart, F. C. Den Boer, M. C. Boonstra, R. S. Hijmans, S. Janki, T. Bazuin, E. Dijkema, E. G. M. Van Geffen, J. J. Atema, W.A.A. Borstlap, J. W. A. Burger, E. B. van Duyn, T.S. Aukema, L. R. Moolenaar, C. J. C. HoffHol, Jarno Melenhorst, J. van Hilst, G. A. Martini, Brechtje A. Grotenhuis, Arthur R. Wijsmuller, Pieter J. Tanis, Esther C. J. Consten, A. A. W. van Geloven, H. T. J. Mantel, Niels F. M. Kok, A. H. C. Gielen, Ignace H. J. T. de Hingh
article en

Abstract

Abstract 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.

Techniques in Coloproctology
University Medical Center Groningen (NL), Radboud University Nijmegen (NL), Heidelberg University (DE), Leiden University Medical Center (NL), Maastricht University Medical Centre (NL), Catharina Ziekenhuis (NL), University Hospital Heidelberg (DE), Radboud University Medical Center (NL), University Medical Center Utrecht (NL), Medisch Centrum Haaglanden (NL), St. Antonius Ziekenhuis (NL), Oncode Institute (NL), Isala (NL), Erasmus MC Cancer Institute (NL), Amsterdam University Medical Centers (NL), Meander Medisch Centrum (NL)
KWF Kankerbestrijding
Good health and well-being
Openalex Percentile: Top 14%
Colorectal Cancer Surgical Treatments
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.