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Racial/Ethnic Disparities in the Era of Minimally Invasive Surgery for Treatment of Colorectal Cancer.
Riner, Andrea N; Herremans, Kelly M; Deng, Xiaoyan; Bandyopadhyay, Dipankar; Wexner, Steven D; Trevino, Jose G; Sharp, Stephen P.
Afiliación
  • Riner AN; Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
  • Herremans KM; Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
  • Deng X; Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA.
  • Bandyopadhyay D; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA.
  • Wexner SD; Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA.
  • Trevino JG; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA.
  • Sharp SP; Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Ann Surg Oncol ; 30(11): 6748-6759, 2023 Oct.
Article en En | MEDLINE | ID: mdl-37423924
ABSTRACT

BACKGROUND:

Minimally invasive (laparoscopic and robotic) surgery (MIS) for colorectal cancer is associated with improved outcomes. We sought to characterize possible disparities in surgical approach and outcomes. PATIENTS AND

METHODS:

In this cross-sectional study, colorectal adenocarcinoma cases among non-Hispanic white (NHW), non-Hispanic Black (NHB), and Hispanic patients were identified using the National Cancer Database (2010-2017). Logistic and Poisson regressions, generalized logit models, and Cox proportional hazards were used to assess outcomes, with reclassification of surgery type if converted to open.

RESULTS:

NHB patients were less likely to undergo robotic surgery. After multivariable analysis, NHB patients were 6% less likely, while Hispanic patients were 12% more likely to undergo a MIS approach. Lymph node retrieval was higher (> 1.3% more, p < 0.0001) and length of stay was shorter (> 17% shorter, p < 0.0001) for MIS approaches. Unplanned readmission was lower for MIS colon cancer operations compared with open operations, but not for rectal cancer. Race/ethnicity-adjusted risk of death was lower with MIS approaches for colon as well as rectal cancer. After adjusting for surgery type, risk of death was 12% lower for NHB and 35% lower for Hispanic patients compared with NHW patients. Hispanic patients had 21% lower risk of death, while NHB patients had 12% higher risk of death than NHW patients with rectal cancer, after adjusting for surgery type.

CONCLUSIONS:

Racial/ethnic disparities exist in utilization of MIS for colorectal cancer treatment, disproportionately affecting NHB patients. Since MIS has the potential to improve outcomes, suboptimal access may contribute to harmful and thus unacceptable disparities in survivorship.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Neoplasias del Recto / Neoplasias Colorrectales / Laparoscopía Tipo de estudio: Observational_studies / Prevalence_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Neoplasias del Recto / Neoplasias Colorrectales / Laparoscopía Tipo de estudio: Observational_studies / Prevalence_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos