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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

Diseases of the Colon & Rectum: May 2012 - Volume 55 - Issue 5 - p 501–508
doi: 10.1097/DCR.0b013e318249ce5a
Original Contribution

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.

1Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut

2Division of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut

3Cancer Outcomes Policy and Effectiveness Research Center, Yale University School of Medicine and Yale Comprehensive Cancer Center, New Haven, Connecticut

4Colon and Rectal Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut

Financial Disclosure: Drs Fox and Gross are involved with the Clinical Scholar’s Program which is supported by the Robert Wood Johnson Foundation.

Disclaimers: The views expressed in this article are those of the authors and do not reflect the official policy of the US Air Force, Department of Defense, or the US Government.

Correspondence: Justin Fox, M.D., 333 Cedar St, SHM-1E-61, PO Box 208088, New Haven, CT 06520-8088. E-mail:

© The ASCRS 2012