Alexander T Hawkins, MD, MPH, Mm Cone, B Hopkins, R Muldoon, MD, Aa Parikh, Tm Geiger. Vanderbilt University
INTRODUCTION: Level one evidence has shown that minimally invasive surgery (MIS) for colon cancer improves short term outcomes with equivalent long-term oncologic results when compared to open surgery. However the adoption of MIS for patients with colon cancer has not been universal. The goal of this study is to identify barriers to the use of MIS surgery in colon cancer resection across the United States.
METHODS AND PROCEDURES: The National Cancer Database was queried for all cases of colonic adenocarcinoma resection from 2010-2012. Patients undergoing an MIS approach were compared with those undergoing open surgery (OS). MIS was defined as either robotic or laparoscopic surgery. Patients with metastatic disease or surgery for palliation were excluded. Multivariable modeling was used to identify variables associated with the use of open surgery.
RESULTS: 124,205 cases were identified. An open approach was used in 69,584 (56%) patients. Patients with stage II (59%), or III (60%) disease were more likely to undergo an open approach than patients with stage I disease (49%) (p<0.001). In a multivariable model adjusting for stage and tumor size (see Table), a number of important factors were associated with an open approach including age > 65 (OR 1.09; p<.0001) , black race (OR 1.12; p<.0001), lack of insurance (OR 1.76; p<.0001), lower education (OR 1.13; p<.0001), lower income (OR 1.20; p<.0001), treatment at a community program (OR 1.18; p<.0001) and treatment at a low volume center (OR 1.62; p<.0001). Utilization of MIS increased over the study period (2010: 38.7%, 2011: 44.0%, 2012: 49.1%; p < .0001).
CONCLUSION(S): MIS approach is utilized in less than half of all colon resections in this national database accounting for over 70% of all diagnosed cancers in the US. Significant variability exists among age, race, insurance status, socioeconomic status, region, and facility type. In light of the recognized benefits of the MIS approach, local and national policy should focus on narrowing these disparities and continuing the upward trend of MIS utilization.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78772
Program Number: S138
Presentation Session: Colorectal 2
Presentation Type: Podium