Deborah S Keller, MS, MD1, Anthony J Senagore, MS, MD, MBA2. 1Baylor University Medical Center, 2University of Texas Medical Branch at Galveston
Background: Despite proven safety and efficacy, reported rates of laparoscopic surgery for rectal cancer in the United States are low. With recent reports of inferiority compared to open surgery for rectal cancer, and movements to standardize techniques and develop centers of excellence, investigating current utilization and predictors of laparoscopy for rectal cancer resection are warranted. Our goal was to evaluate the current utilization and identify factors impacting use of laparoscopic surgery for rectal cancer.
Methods: The Premier Hospital Database was reviewed for elective inpatient resections for rectal cancer (2010 through Q3 2015). Patients were identified by ICD-9-CM diagnosis codes for rectal cancer or carcinoma-in-situ, then stratified into open or laparoscopic approaches by ICD-9-CM procedure codes or billing charge. A logistic multivariate regression model identified variables predictive of using laparoscopy for rectal cancer. The Cochran-Armitage test was used for trend analysis. The main outcome measures were trends in utilization and factors independently associated with use of laparoscopy for curative rectal cancer resection.
Results: 3,336 patients were included- 43.8% laparoscopic (n=1,464) and 56.2% open (n=1,872). Use of laparoscopy increased from 37.6% to 55.3% during the study period (p<0.0001). General surgeons performed the majority of all resections, but colorectal surgeons were more likely to approach rectal cancer laparoscopically (41.31% vs 36.65%, OR 1.082, 95% CI [0.92, 1.27], p<0.3363). Higher volume surgeons were more likely to use laparoscopy than low volume surgeons (OR=3.72, 95%CI: [2.64, 5.25], p<0.0001). Younger patients (OR 1.49, 95% CI [1.03, 2.17], p=0.036) with minor (OR 2.13, 95% CI (1.45, 3.12), p<0.0001) or moderate illness severity (OR 1.582, 95% CI [1.08, 2.31], p<0.0174) were more likely to receive a laparoscopic procedure. Teaching hospitals (OR=0.842, 95% CI [0.710, 0.997], p=0.0463) and hospitals in the Midwest (OR=0.69, 95% CI [0.54, 0.89, p=0.0044) were less likely to use laparoscopy. Insurance status and hospital size did not significantly impact use of laparoscopy for rectal cancer.
Conclusions: The use of laparoscopy for rectal cancer has steadily increased over the years examined. Patient, provider, and regional variables exist, with hospital status, geographic location, and colorectal specialization impacting the likelihood receiving laparoscopic rectal cancer surgery. However, surgeon volume had the greatest influence. These results emphasize the importance of training and surgeon specific outcomes to increase utilization, surgical quality, and improve patient recovery in appropriate cases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78889
Program Number: P238
Presentation Session: Poster (Non CME)
Presentation Type: Poster
