Cohort study of association of travel to high-volume centers with survival after esophagectomy for cancer

Ongoing efforts have encouraged the regionalization of esophageal adenocarcinoma treatment to high-volume centers (HVCs). Yet, such centralization has been linked with increased patient travel burden and reduced postoperative continuity of care. A cohort study using the 2010-2021 National Cancer Database aimed to determine whether traveling to undergo esophagectomy at HVCs is linked with superior overall survival compared with receiving care locally at low-volume centers (LVCs). In this cohort study of data for 17,970 patients, traveling longer distances to receive care at HVCs was associated with significantly improved overall survival at 1 year (HR 0.69; 95% CI 0.58-0.83) and at 5 years (0.80; 0.70-0.90) compared with treatment at local LVCs. Stratifying by stage, traveling to HVCs was associated with comparable outcomes for stage I disease but reduced mortality for stage III (1-year HR 0.72; 95% CI 0.60-0.87; 5-year 0.83; 0.74-0.93). Additionally, traveling to HVCs was associated with greater lymph node harvest and likelihood of margin-negative resection. The authors conclude that traveling to HVCs for esophagectomy was associated with improved 1-year and 5-year survival compared with receiving care locally at LVCs.