This retrospective cohort study used the National Cancer Database (2015–2021) to examine how far patients with stage II–III rectal adenocarcinoma (n=40,216) traveled to receive proctectomy, and whether travel distance was associated with perioperative and long-term outcomes.
Median travel distance was 13 miles (IQR 5.7–31.4). Patients traveling the farthest (Q4 vs. Q1) had significantly better overall survival (HR 0.850, 95% CI 0.758–0.953, P=0.005). Longer travel was not associated with lower conversion-to-laparotomy rates, 30-day mortality, or higher lymph node yield.
Retrospective design limits causal inference. The NCDB does not capture why patients traveled farther (e.g., referral patterns vs. personal choice), which may confound the survival association. Cause-specific survival data are unavailable in the NCDB, so only overall survival could be assessed.
Patients with rectal cancer who travel greater distances for surgery tend to have better overall survival, likely reflecting treatment at higher-volume or academic centers. Clinicians should consider referral to specialized centers for stage II–III rectal cancer, particularly for patients in rural or low-resource settings.
