Trends and Outcomes of Surgical Treatment for Colorectal Cancer between 2004 and 2012- an Analysis using National Inpatient Database

Abstract

Limited data are available for the epidemiology and outcome of colorectal cancer in relation to the three main surgical treatment modalities (open, laparoscopic and robotic). Using the US National Inpatient Sample database from 2004 to 2012, we identified 1,265,684 hospitalized colorectal cancer patients. Over the 9 year period, there was a 13.5% decrease in the number of hospital admissions and a 43.5% decrease in in-hospital mortality. Comparing the trend of surgical modalities, there was a 35.4% decrease in open surgeries, a 3.5 fold increase in laparoscopic surgeries, and a 41.3 fold increase in robotic surgeries. Nonetheless, in 2012, open surgery still remained the preferred surgical treatment modality (65.4%), followed by laparoscopic (31.2%) and robotic surgeries (3.4%). Laparoscopic and robotic surgeries were associated with lower in-hospital mortality, fewer complications, and shorter length of stays, which might be explained by the elective nature of surgery and earlier tumor grades. After excluding patients with advanced tumor grades, laparoscopic surgery was still associated with better outcomes and lower costs than open surgery. On the contrary, robotic surgery was associated with the highest costs, without substantial outcome benefits over laparoscopic surgery. More studies are required to clarify the cost-effectiveness of robotic surgery.

Figure 1

The trend of colon cancer admission (A) and in-hospital mortality (B) between 2004 and 2012. Circle represents the number of admissions/deaths in a given year, the straight line is a linear regression on all the data points, and the shaded area represents the 95% confidence limits for the linear regression.

Figure 2

The number of colorectal surgeries, according to the type of surgeries, from 2008 to 2012. (A) Trends in the number of open vs. laparoscopic surgery (B) Trend in the number of laparoscopic vs robotic surgery. Circle represents the number of surgeries in a given year, the straight line is a linear regression on all the data points, and the shaded area represents the 95% confidence limits for the linear regression.

Figure 3

In-hospital mortality rate according to the type of surgeries, from 2008 to 2012. Circle represents the mortality rate in a given year, the straight line is a linear regression on all the data points, and the shaded area represents the 95% confidence limits for the linear regression.