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Robotic proctectomy for rectal cancer in the US: a skewed population

  • 2019 SAGES Oral
  • Published:
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Abstract

Background

Socioeconomic and racial differences have been associated with disparities in cancer care within the US, including disparate access to minimally invasive surgery for rectal cancer. We hypothesized that robotic approach to rectal cancer may be associated with similar disparities.

Methods

The National Cancer Database (NCDB) was used to identify patients over 18 years old with clinical stage I–III rectal adenocarcinoma who underwent a proctectomy between 2010 and 2014. Demographic and hospital factors were analyzed for association with robotic approach. Factors identified on bivariate analyses informed multivariate analysis.

Results

We identified 33,503 patients who met inclusion criteria; 3702 (11.1%) underwent robotic surgery with 7.8% conversion rate. Patients who received robotic surgery were more likely to be male, white, privately insured and with stage III cancer. They were also more likely to live in a metropolitan area, more than 25 miles away from the hospital and with a higher high school graduation rate. The treating hospital was more likely to be academic and high volume.

Conclusions

Robotic surgery is performed rarely and access to it is limited for patients who are female, black, older, non-privately insured and unable to travel to high-volume teaching institutions. The advantages of robotic surgery may not be available to all patients given disparate access to the robot. This inherent bias in access to robot may skew study populations, preventing generalizability of robotic surgery research.

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Acknowledgements

We acknowledge the support of the University Hospitals Cleveland Medical Center Surgery Department and UH-RISES: Research in Surgical Outcomes & Effectiveness Center.

Funding

This investigation was funded by the University Hospitals Cleveland Medical Center Surgery Department.

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Authors and Affiliations

  1. Department of Surgery, University Hospitals Research in Surgical Outcome & Effectiveness (UH-RISES), University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Avenue, LKS 5047, Cleveland, OH, 44106, USA

    Asya Ofshteyn, Katherine Bingmer, Christopher W. Towe, Emily Steinhagen & Sharon L. Stein

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  1. Asya Ofshteyn
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  2. Katherine Bingmer
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  3. Christopher W. Towe
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  4. Emily Steinhagen
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Corresponding author

Correspondence to Sharon L. Stein.

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Disclosures

Dr. Stein has been a speaker for Merck and advisory consultant for Medtronics. Dr. Towe is a consultant for Medtronic, Atricure, Sig Medical, and Zimmer Biomet. Drs. Steinhagen, Bingmer and Ofshteyn have no conflicts of interest or financial ties to disclose.

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Ofshteyn, A., Bingmer, K., Towe, C.W. et al. Robotic proctectomy for rectal cancer in the US: a skewed population. Surg Endosc 34, 2651–2656 (2020). https://doi.org/10.1007/s00464-019-07041-0

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  • DOI: https://doi.org/10.1007/s00464-019-07041-0

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