The Geography of Liver Resection: Travel Distance, Facility Volume, and Access to Specialized Care in an Urban Setting.

BACKGROUND: Liver resection for colorectal liver metastases (CRLM) is a potentially curative treatment that is underutilized. Population-level data on disparities in access to liver surgery have been described, but municipality-level data are lacking. METHODS: New York State Cancer Registry (NYSCR) and New York Statewide Planning and Research Cooperative System (SPARCS) datasets were linked to identify patients with synchronous, liver-only CRLM in New York State (NYS) and New York City (NYC) between 2010 and 2020. Demographic and treatment details were reviewed and patients were compared by using Pearson's chi-squared and Welch's t-tests. Geo-mapping was performed to determine driving distances between patient home addresses and their treating facility. RESULTS: Of 3,765 patients in NYS, 2,609 lived in NYC. The CRLM resection rate in NYS was 24% and 20% in NYC. Within NYC, treatment at a low-volume liver surgery facility (odds ratio [OR] 0.23, p < 0.001), positive primary lymph nodes (OR 0.34, p < 0.001), Medicare insurance (OR 0.62, p = 0.004), diagnosis of CRLM in 2015-2020 (OR 0.66, p < 0.001), and older age (OR 0.98, p < 0.001) were associated with a decreased likelihood of undergoing liver resection. History of prior colorectal resection (OR 4.44, p < 0.001) and farther distance to the treating facility (OR 1.03, p = 0.001) were associated with increased likelihood of undergoing resection. Within the unresected group, 18% bypassed a closer high-volume center for treatment at a farther low-volume center. CONCLUSIONS: Patients in NYC had lower rates of CRLM resection than in NYS. We identified municipality-level disparities in the receipt of liver surgery for CRLM, laying the foundation for the implementation of local interventions.