Cornelis M Hoogerboord, MBChB, MMed, Min Hu, MA, Richard Y Liu, MD, Gordon J Flowerdew, DSc, Adrian R Levy, PhD, Geoffrey A Porter, MD, MSc. Dalhousie University
Background: Although the safety and efficacy of laparoscopic surgery in colon cancer have been established, the uptake of laparoscopic colectomy for cancer (LAC) in Canada is not known. We sought to describe the uptake and use of LAC from 2004 to 2015 in Canada, and to identify patient, surgeon and system related factors associated with its use.
Design: This population-based cohort study used a national hospital discharge abstract database to identify all patients undergoing non-emergency colectomy for cancer in all provinces except Quebec from 2004 to 2015. Type of resection (laparoscopic or open) was determined based on procedure codes within the discharge abstract database. Multiple logistic regression was used to identify factors associated with LAC.
Main outcome measures: Proportional rates of LAC (overall and annual) at national and provincial level.
Results: Among the 63,504 cases overall, 19,691 (31.0%) involved LAC. The proportion of patients undergoing LAC increased from 9.2% in 2004 to 51.5% in 2015 in a relatively constant fashion. There were marked differences in rates of LAC by province (P < 0.001); in 2015 this ranged from 11.2% in Newfoundland to 60.2% in British Columbia. On multivariate analysis, factors associated with increased use of LAC included female gender, urban residence, geographical region (i.e. province), and hospital and surgeon volume of colectomies. LAC was used less in older patients and those with a higher Elixhauser comorbidity index (Table 1).
Conclusions: Although there has been considerable uptake of LAC in Canada over the past ten years, wide interprovincial variation exists. Analyses of factors associated with LAC suggest both patient selection and practice patterns likely contribute to its uptake.
Table 1. Factors associated with laparoscopic colectomy for cancer
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77674
Program Number: P223
Presentation Session: Poster (Non CME)
Presentation Type: Poster