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Disparities in utilization of robotic surgery for colon cancer: an evaluation of the U.S. National Cancer Database

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Abstract

Despite the benefits of minimally invasive surgery for colorectal procedures, significant disparities in access to these techniques remain. While these gaps have been well-documented for laparoscopy, few studies have evaluated inequalities in access to robotic surgery. We analyze whether disparities exist in the use of robotic surgery in the management of colon cancer. The U.S. National Cancer Database was queried for patients with non-metastatic colon adenocarcinoma who underwent resection with the robotic platform (2010–2016). Demographic, clinicopathologic, and treatment facility-related variables were analyzed with respect to preferential utilization of robotic surgery with multivariable logistic regression. Patients with metastatic disease, missing or incomplete surgical information, and those who underwent local tumor excision were excluded. 74,984 patients were identified, 3001 (4%) of whom underwent robotic surgery. In multivariable analysis, patients who were older, Black, or were living in an urban area had decreased odds of receiving robotic surgery compared with open or laparoscopic surgery. Patients who were privately insured or living in areas with higher education had increased odds of receiving robotic surgery. Robotic surgery was also preferentially associated with lower clinical stage, more recent year of diagnosis, and hospitals with higher procedural volume. As advantages of the robotic platform are becoming better understood, use of this approach is increasing in popularity for treatment of non-metastatic colon cancer. Despite this, significant disparities exist with respect to patient demographics and socioeconomic factors, and access may only be limited to certain types of hospitals. Further studies are needed to define why these inequalities exist.

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References

  1. Jackson TD, Kaplan GG, Arena G et al (2007) Laparoscopic versus open resection for colorectal cancer: a metaanalysis of oncologic outcomes. J Am Coll Surg 204:439

    Article  PubMed  Google Scholar 

  2. Siddiqui MR, Sajid MS, Khatri K et al (2010) Elective open versus laparoscopic sigmoid colectomy for diverticular disease: a meta-analysis with the Sigma trial. World J Surg 34:2883

    Article  PubMed  Google Scholar 

  3. Yamada T, Okabayashi K, Hasegawa H et al (2016) Meta-analysis of the risk of small bowel obstruction following open or laparoscopic colorectal surgery. Br J Surg 103:493

    Article  CAS  PubMed  Google Scholar 

  4. Bartels SA, Gardenbroek TJ, Ubbink DT et al (2013) Systematic review and meta-analysis of laparoscopic versus open colectomy with end ileostomy for non-toxic colitis. Br J Surg 100:726

    Article  CAS  PubMed  Google Scholar 

  5. Kiran RP, El-Gazzaz GH, Vogel JD, Remzi FH (2010) Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 211:232

    Article  PubMed  Google Scholar 

  6. Reza MM, Blasco JA, Andradas E et al (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93:921

    Article  CAS  PubMed  Google Scholar 

  7. Neale JA, Reickert C, Swartz A et al (2014) Accuracy of national surgery quality improvement program models in predicting postoperative morbidity in patients undergoing colectomy. Perm J 18:14

    Article  PubMed  PubMed Central  Google Scholar 

  8. Webb S, Rubinfeld I, Velanovich V et al (2012) Using National Surgical Quality Improvement Program (NSQIP) data for risk adjustment to compare Clavien 4 and 5 complications in open and laparoscopic colectomy. Surg Endosc 26:732

    Article  PubMed  Google Scholar 

  9. Bonjer HJ, Hop WC, Nelson H et al (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298

    Article  PubMed  Google Scholar 

  10. Sheetz KH, Norton EC, Dimick JB, Regenbogen SE (2019) Perioperative outcomes and trends in the use of robotic colectomy for medicare beneficiaries from 2010 through 2016. JAMA Surg 155:41

    Article  PubMed Central  Google Scholar 

  11. Sheetz KH, Claflin J, Dimick JB (2020) Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open 3:e1918911

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chen CC, Falcone T (2009) Robotic gynecologic surgery: past, present, and future. Clin Obstet Gynecol 52(3):335–343. https://doi.org/10.1097/GRF.0b013e3181b08adf

    Article  PubMed  Google Scholar 

  13. Kim SP, Boorjian SA, Shah ND, Weight CJ, Tilburt JC, Han LC, Thompson RH, Trinh QD, Sun M, Moriarty JP, Karnes RJ (2013) Disparities in access to hospitals with robotic surgery for patients with prostate cancer undergoing radical prostatectomy. J Urol 189(2):514–520. https://doi.org/10.1016/j.juro.2012.09.033 (Epub 2012 Dec 17 PMID: 23253307)

    Article  PubMed  Google Scholar 

  14. Blake EA, Sheeder J, Behbakht K, Guntupalli SR, Guy MS (2016) Factors impacting use of robotic surgery for treatment of endometrial cancer in the United States. Ann Surg Oncol. https://doi.org/10.1245/s10434-016-5252-x

    Article  PubMed  Google Scholar 

  15. Turner M, Adam MA, Sun Z et al (2017) Insurance status, not race, is associated with use of minimally invasive surgical approach for rectal cancer. Ann Surg 265(4):774–781. https://doi.org/10.1097/SLA.0000000000001781

    Article  PubMed  Google Scholar 

  16. Gabriel E, Thirunavukarasu P, Al-Sukhni E, Attwood K, Nurkin SJ (2016) National disparities in minimally invasive surgery for rectal cancer. Surg Endosc 30(3):1060–1067. https://doi.org/10.1007/s00464-015-4296-5 (Epub 2015 Jun 20. PMID: 26092020; PMCID: PMC5322799)

    Article  PubMed  Google Scholar 

  17. Hawkins AT, Ford MM, Benjamin Hopkins M, Muldoon RL, Wanderer JP, Parikh AA, Geiger TM (2018) Barriers to laparoscopic colon resection for cancer: a national analysis. Surg Endosc 32(2):1035–1042. https://doi.org/10.1007/s00464-017-5782-8 (Epub 2017 Aug 24 PMID: 28840352)

    Article  PubMed  Google Scholar 

  18. Sastow DL, White RS, Mauer E, Chen Y, Gaber-Baylis LK, Turnbull ZA (2019) The disparity of care and outcomes for medicaid patients undergoing colectomy. J Surg Res 235:190–201. https://doi.org/10.1016/j.jss.2018.09.056 (Epub 2018 Oct 29 PMID: 30691794)

    Article  PubMed  Google Scholar 

  19. Faculty of the American College of Surgeons Commission on Cancer (2018) About cancer program categories. Retrieved from: https://www.facs.org/quality-programs/cancer/coc/accreditation/categories. Accessed 12 Dec 2020

  20. Augustus GJ, Ellis NA (2018) Colorectal cancer disparity in African Americans: risk factors and carcinogenic mechanisms. Am J Pathol [Internet] 188(2):291–303. https://doi.org/10.1016/j.ajpath.2017.07.023

    Article  Google Scholar 

  21. Sineshaw HM, Ng K, Flanders WD, Brawley OW, Jemal A (2018) Factors that contribute to differences in survival of Black vs White patients with colorectal cancer. Gastroenterology [Internet] 154(4):906-915.e7

    Article  Google Scholar 

  22. Le H, Ziogas A, Lipkin SM, Zell JA (2008) Effects of socioeconomic status and treatment disparities in colorectal cancer survival. Cancer Epidemiol Biomarkers Prev 17(8):1950–1962

    Article  PubMed  Google Scholar 

  23. Jones LA, Ferrans CE, Polite BN, Brewer KC, Maker AV, Pauls HA, Rauscher GH (2017) Examining racial disparities in colon cancer clinical delay in the colon cancer patterns of care in Chicago study. Ann Epidemiol 27(11):731-738.e1. https://doi.org/10.1016/j.annepidem.2017.10.006 (Epub 2017 Oct 13. PMID: 29173578; PMCID: PMC5728690)

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gabriel E, Ostapoff K, Attwood K, Al-Sukhni E, Boland P, Nurkin S (2017) Disparities in the age-related rates of colorectal cancer in the United States. Am Surg 83(6):640–647 (PMID: 28637568)

    Article  PubMed  Google Scholar 

  25. Cabo J, Shu X, Shu XO, Parikh A, Bailey C (2020) Treatment at academic centers decreases insurance-based survival disparities in colon cancer. J Surg Res 245:265–272. https://doi.org/10.1016/j.jss.2019.07.059 (Epub 2019 Aug 14 PMID: 31421372)

    Article  PubMed  Google Scholar 

  26. Du XL, Meyer TE, Franzini L (2007) Meta-analysis of racial disparities in survival in association with socioeconomic status among men and women with colon cancer. Cancer 109(11):2161–2170. https://doi.org/10.1002/cncr.22664 (PMID: 17455219)

    Article  PubMed  Google Scholar 

  27. Abdel-Rahman O (2019) Outcomes of non-metastatic colon cancer patients in relationship to socioeconomic status: an analysis of SEER census tract-level socioeconomic database. Int J Clin Oncol 24(12):1582–1587. https://doi.org/10.1007/s10147-019-01497-9 (Epub 2019 Jun 25 PMID: 31240498)

    Article  PubMed  Google Scholar 

  28. Pulte D, Jansen L, Brenner H (2018) Disparities in colon cancer survival by insurance type: a population-based analysis. Dis Colon Rectum 61(5):538–546. https://doi.org/10.1097/DCR.0000000000001068 (PMID: 29624548)

    Article  PubMed  Google Scholar 

  29. Gill AA, Enewold L, Zahm SH et al (2014) Colon cancer treatment: are there racial disparities in an equal-access healthcare system? Dis Colon Rectum 57(9):1059–1065. https://doi.org/10.1097/DCR.0000000000000177

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ferlay JSI, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray, F (2013) GLOBOCAN 2012 v10, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. International Agency for Research on Cancer, Lyon

  31. Jung KW, Park S, Kong HJ, Won YJ, Lee JY, Seo HG, Lee JS (2012) Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2009. Cancer Res Treat 44:11–24

    Article  PubMed  PubMed Central  Google Scholar 

  32. Matsuda A, Matsuda T, Shibata A, Katanoda K, Sobue T, Nishimoto H (2014) Cancer incidence and incidence rates in Japan in 2008: a study of 25 population-based cancer registries for the monitoring of cancer incidence in Japan (MCIJ) project. Jpn J Clin Oncol 44:388–396

    Article  PubMed  Google Scholar 

  33. Kim SE, Paik HY, Yoon H, Lee JE, Kim N, Sung MK (2015) Sex- and gender-specific disparities in colorectal cancer risk. World J Gastroenterol 21(17):5167–5175. https://doi.org/10.3748/wjg.v21.i17.5167.PMID:25954090;PMCID:PMC4419057

    Article  PubMed  PubMed Central  Google Scholar 

  34. Keller DS, Parikh N, Senagore AJ (2017) Predicting opportunities to increase utilization of laparoscopy for colon cancer. Surg Endosc 31(4):1855–1862. https://doi.org/10.1007/s00464-016-5185-2 (Epub 2016 Aug 29 PMID: 27572064)

    Article  PubMed  Google Scholar 

  35. Ofshteyn A, Bingmer K, Towe CW, Steinhagen E, Stein SL (2020) Robotic proctectomy for rectal cancer in the US: a skewed population. Surg Endosc 34(6):2651–2656. https://doi.org/10.1007/s00464-019-07041-0 (Epub 2019 Aug 1 PMID: 31372887)

    Article  PubMed  Google Scholar 

  36. Lo BD, Leeds IL, Sundel MH (2020) Frailer patients undergoing robotic colectomies for colon cancer experience increased complication rates compared with open or laparoscopic approaches. Dis Colon Rectum 63(5):588–597

    Article  PubMed  Google Scholar 

  37. Horsey ML, Parascandola SA, Sparks AD, Hota S, Ng M, Obias V (2021) The impact of surgical approach on short- and long-term outcomes after rectal cancer resection in elderly patients: a national cancer database propensity score matched comparison of robotic, laparoscopic, and open approaches. Surg Endosc. https://doi.org/10.1007/s00464-021-08401-5 (Epub ahead of print)

    Article  PubMed  Google Scholar 

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Funding

This study was performed without grant support or support from other financial relationships.

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Authors and Affiliations

  1. Walter Reed National Military Medical Center, Bethesda, MD, USA

    Michael L. Horsey

  2. Department of Surgery, George Washington University, Washington, D.C., USA

    Debra Lai & Andrew D. Sparks

  3. George Washington University School of Medicine and Health Sciences, Washington, D.C., USA

    Aalap Herur-Raman & Sanjana Rao

  4. Department of Gastroenterology at the George, Washington University Hospital, Washington, D.C., USA

    Marie Borum

  5. Department of Colon and Rectal Surgery at the George Washington University Hospital, Washington, D.C., USA

    Matthew Ng & Vincent J. Obias

Authors
  1. Michael L. Horsey
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  2. Debra Lai
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  4. Aalap Herur-Raman
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  5. Marie Borum
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  7. Matthew Ng
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  8. Vincent J. Obias
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Correspondence to Michael L. Horsey.

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Conflict of interest

Dr. Michael L. Horsey, Dr. Debra Lai, Mr. Andrew D. Sparks, Mr. Aalap Herur-Raman, Dr. Marie Borum, Dr. Sanjana Rao, and Dr. Matthew Ng declares that they have no conflict of interest. Dr. Vincent J. Obias has received speaker honoraria from Medrobotics, Medtronic, and Intuitive.

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This study was analyzed by the George Washington University Institutional Review Board and deemed to be exempt from review.

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Horsey, M.L., Lai, D., Sparks, A.D. et al. Disparities in utilization of robotic surgery for colon cancer: an evaluation of the U.S. National Cancer Database. J Robotic Surg 16, 1299–1306 (2022). https://doi.org/10.1007/s11701-022-01371-3

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  • DOI: https://doi.org/10.1007/s11701-022-01371-3

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