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

Authors

Michael L. Horsey, Walter Reed National Military Medical Center, Bethesda, MD, USA. Michael.horsey1@gmail.com.
Debra Lai, Department of Surgery, George Washington University, Washington, D.C., USA.
Andrew D. Sparks, Department of Surgery, George Washington University, Washington, D.C., USA.
Aalap Herur-Raman, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
Marie Borum, Department of Gastroenterology at the George, Washington University Hospital, Washington, D.C., USA.
Sanjana Rao, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
Matthew Ng, Department of Colon and Rectal Surgery at the George Washington University Hospital, Washington, D.C., USA.
Vincent J. Obias, Department of Colon and Rectal Surgery at the George Washington University Hospital, Washington, D.C., USA.

Document Type

Journal Article

Publication Date

1-20-2022

Journal

Journal of robotic surgery

DOI

10.1007/s11701-022-01371-3

Keywords

Colon cancer; Healthcare disparities; Robotic surgery

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.

APA Citation

Horsey, Michael L.; Lai, Debra; Sparks, Andrew D.; Herur-Raman, Aalap; Borum, Marie; Rao, Sanjana; Ng, Matthew; and Obias, Vincent J., "Disparities in utilization of robotic surgery for colon cancer: an evaluation of the U.S. National Cancer Database" (2022). GW Authored Works. Paper 244.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/244

Department

Surgery