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. 2023 Oct;30(11):6748-6759.
doi: 10.1245/s10434-023-13693-z. Epub 2023 Jul 9.

Racial/Ethnic Disparities in the Era of Minimally Invasive Surgery for Treatment of Colorectal Cancer

Andrea N Riner  1 , Kelly M Herremans  1 , Xiaoyan Deng  2   3 , Dipankar Bandyopadhyay  2   3 , Steven D Wexner  4 , Jose G Trevino  5   3 , Stephen P Sharp  6
Affiliations

Racial/Ethnic Disparities in the Era of Minimally Invasive Surgery for Treatment of Colorectal Cancer

Andrea N Riner et al. Ann Surg Oncol. 2023 Oct.

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.

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Figures

FIG. 1
FIG. 1
Trends in surgical approach for colorectal cancer surgery in the USA, by race/ethnicity. From 2010 to 2017, there has been a steady decline in the use of open surgery; between minimally invasive techniques, robotic surgery has experienced a more rapid increase. These trends were seen across racial/ethnic groups, but non-Hispanic Black patients have consistently higher rates of open surgery and lower rates of robotic surgery compared to non-Hispanic white and Hispanic patients, while the use of laparoscopic surgery equalized between racial/ethnic groups by 2016
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