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Large hospital or small town hospital?

Posts: 5
Joined: Jul 2007

My father has just been diagnosed with rectal cancer. He will need to have surgery and a permanent colostomy. He is 64 years old. We live in Wisconsin and he is wondering if he should have the surgery at "Marshfield," a larger hospital or at our hometown hospital. Any thoughts on this? Would his outcome be better at a larger hospital? Thank you and God Bless.

StacyGleaso's picture
Posts: 1249
Joined: Mar 2003

To quote John Mellencamp, "I was born in a small town, I live in a small town."

However, when dealing with cancer, size matters! I truly believe bigger is better. Equipment is more "state of the art", technology is more current, and the physicians are typically exposed to more senarios, thus, more experiences.

If I would have stayed local for my surgery, I would have been cut two days after diagnosis. Instead, the larger hospital (University of Chicago) instructed me to have radiation and chemo prior to surgery in order to make the surgery more successful. My surgeon was one of the top three in the WORLD, not just in the US. I was stage 4, and today, nearly 6 yrs later, I'm a big ZERO! (that's a good thing! lol)

Best wishes for smooth sailing,


goldfinch's picture
Posts: 737
Joined: Oct 2003

I love small hospitals. They provide a wonderful family like atmosphere.
BUT!!!!! For cancer, the bigger hospitals are the way to go, for the same reasons as Stacy said.
Good Luck!

nudgie's picture
Posts: 1482
Joined: Sep 2006

I really can't give you an opinion but I can give you my scearnio:

I was borned and raised in the Northern Virginia Area (Wash DC Metro area) until I moved to the Eastern Panhandle of West Virginia to the City of Charles Town. Charles Town is a small but growing City with one hospital, Jefferson Memorial and yes I had heard horror stories about WV and their health care, so I got my very first symptons of stomach pains I made my husband travel 30 miles (instead of 4) to the hospital in Loudoun County, Virginia. A month later I was in the ER of Jefferson Memorial and 3 days later emergency surgery at Jefferson Memorial and a year later I am doing GREAT!!!! I was lucky to have a WONDERFUL surgeon, primary care docs and oncologist. The only doctor I now have in Virginia is my primary care and gyn. Onc and surgeon are in West Virginia.

I have visited friends in large huge hospitals like Fairfax Hospital, Loudoun Hospital, VA Hospital, etc.

You can get the same care in a small as you can in "large" well known hospital. The advantages of larger hospitals is the equipment, number of staff, beds, pay, but sometimes the patients become only "numbers".

Do some reach, talk with your doctor and onoclogist and let them help.

Posts: 119
Joined: Jan 2007


Your post caught my eye, I'm a lifelong West Virginian. Too bad that WV gets such a bad rap, I have the best onc around and we have a great cancer center here that's up on the latest. I'm located in Charleston. Couldn't resist saying "hi"!

Posts: 63
Joined: Nov 2004

I would not be as concerned about the size of the hospital as much as getting a colon and rectal surgeon versus a general surgeon. Stacy raises a good point in that some rectal cancer patients have chemo and radiation prior to surgery and do not need a permanent ostomy. A NCI-designated comprehensive cancer center would be ideal but not everyone has that option. We live in Atlanta and Georgia is the most populous state without one of those centers and we have been happy with my husband's care. Feel free to email me off list if you have additional questions (aclay@ccalliance.org).


Joy1216's picture
Posts: 293
Joined: Mar 2006

My surgeon's business card says that he is a general, oncologic, and vascular surgeon. According to the GI doc and the anesthesiologist, he is the best in the metro area. You might want to consider a surgeon who specializes in oncology.

Posts: 190
Joined: Oct 2005

Hello, I was operated on by our little Town General Surgeon in 1993, stage IV. I received a year of chemo there and I am NED today. This no longer happens and we have to travel 3 hours to the nearest large hospital.

I was totally delighted with my care and the outcome. But that is just my storyand things have changed drastically since then.


Posts: 405
Joined: Mar 2007

I agree with everyone else. There are good and bad with both choices. However, We were first told that my husband would have a permanent colostomy when he was initially diagnosed with rectal cancer. The surgeon told us that the tumor was just too low. We went for a second opinion at a large well known hospital and found a surgeon who said he could do an illeostomy and a reversal at a later date. At a larger hospital they are most often more experienced and specialized. Because of this, it was greatly to our benefit to travel to the larger hospital. Maybe you should at least get a second opinion before making your decision. I wish you all the best!


jams67's picture
Posts: 927
Joined: May 2006

Find a specialist.
If my surgery had been done in my small town, where I scheduled it before getting a second opinion from a specialist, at best, I would have had 2 surgeries, one for colon and and another for the 3 tumors on my liver. The surgeon I had scheduled my surgery with was a good general surgeon but had no clue about complicated liver surgery. He would probably have completed the colon surgery and then referred me to another surgeon.
Though it is important to have your surgery soon, there is no rush. Your cancer has been there for a while, and you have time to get another opinion.
Good luck with whatever you decide to do.
Jo Ann

vinny3's picture
Posts: 933
Joined: Jun 2006

I would recommend that your father goes to a place where they have the most experience in dealing with his problem. I am a physician in the Minneapolis area and am familiar with the Marshfield clinic. It is an excellent center but I do not know the surgeons that are there. Your father could opt for someplace like the Mayo Clinic as well. What ever he decides to do it is important for him to get several opinions. I had chemo/radiation first which shrunk the tumor and then had just a local excision. However, the cancer came back and now I have a permanent colostomy. If I had it to do over I probably would go with the larger surgery first followed by chemotherapy rather than have the radiation but was hoping at the time to avoid the colostomy. The reason I'm not sure about the radiation is that it cuts down the accuracy of assessing the lymph nodes if the larger surgery is done later (they shrink and are hard to see). Now that I have one it is not so bad and it is not a problem taking care of it. It does depend upon what stage your father's cancer is. Whatever decision he makes will be correct.


Posts: 5
Joined: Jul 2007

Thank you for your response, expertise and experience. I hope you are doing well.
I went to see the oncologist
yesterday with my father. They are considering Chemo and radiation prior to surgery and then when he turns 65 in November, then he would have the surgery and colostomy. (The reason he is considering this option is that the insurance company is in conflict with the doctor how long his hospital stay should be and if he needs to go in to the hospital a day prior for the "prep.") He does not want to take the chance that his insurance would not cover the entire hospitalization.) He can then get medicare to cover it. It may also, in part, be fear.
His cancer is a grade 2 and the oncologist recommended that he get an "endorectal ultrasound," to determine the stage of the cancer. This is where we are at now. He is still considering getting a second opinion from a "colorectal surgeon." The surgeon he is considering now is a "general surgeon." Thank you for all of your help and also to the many others that replied. My best to all of you.


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