Diseases of the Colon & Rectum

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Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e318249ce5a
Original Contribution

Laparoscopic Colectomy for the Treatment of Cancer Has Been Widely Adopted in the United States

Fox, Justin M.D.1; Gross, Cary P. M.D.1,2,3; Longo, Walter M.D., M.B.A.4; Reddy, Vikram M.D., Ph.D.4

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BACKGROUND: Fewer than 10% of patients with colon cancer in the United States are reportedly treated with a laparoscopic colectomy despite the benefits it has over the open approach. This estimate, however, may be artificially low because of inaccurate case identification.

OBJECTIVE: The aim of this study was to estimate the proportion of colon resections performed laparoscopically for the treatment of colon cancer and to identify factors associated with its use.

DESIGN: This study is a retrospective review of the 2008 to 2009 Nationwide Inpatient Sample.

SETTINGS, PATIENTS, INTERVENTIONS: Adult patients with a diagnosis of colon cancer who underwent an elective colectomy were included.

MAIN OUTCOME MEASURES: The overall proportion of colon resections performed laparoscopically was calculated. Multivariable regression modeling was used to identify patient and hospital characteristics associated with undergoing a laparoscopic procedure.

RESULTS: During the study period, 9075 (weighted = 45,549) patients were identified with 50% treated via the laparoscopic approach. Patients were more likely to undergo a laparoscopic procedure if their median annual income was $63,000+ based on home zip code (adjusted relative risk = 1.08 (1.02–1.16)) and less likely if they were 70+ years of age (adjusted relative risk = 0.93 (0.87–1.00)), female (adjusted relative risk = 0.96 (0.92–0.99)), and had Medicaid (adjusted relative risk =0.84 (0.73–0.97)), or 3+ chronic conditions (adjusted relative risk = 0.84 (0.79–0.89)). Treatment at teaching hospitals (adjusted relative risk =1.10 (1.00–1.20)) and high-volume centers (adjusted relative risk =1.41 (1.22–1.63)) was associated with undergoing a laparoscopic colectomy, whereas treatment at rural hospitals was associated with less frequent use of laparoscopic colectomy (adjusted relative risk = 0.76 (0.64–0.90)).

LIMITATIONS: This study is subject to the limitations of using administrative data.

CONCLUSIONS: There has been widespread adoption of the laparoscopic approach to colon resection for cancer in the United States. Disparities in access remain, with application of this technique favoring patients with a higher socioeconomic status and those able to be treated at higher-volume, academic, and nonrural centers.

© The ASCRS 2012


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