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

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Acknowledgement

Services and products in support of the research project were generated by the VCU Massey Cancer Center Biostatistics Shared Resource, supported in part with funding from NIH-NCI Cancer Center Support Grant P30 CA016059. Authors are supported by the National Human Genome Research Institute (T32 HG008958 to ANR, KMH) and National Cancer Institute (R01 CA242003 to JGT, U54 CA233444 to JGT, U54 CA233444-03S1 to ANR, and JGT) of the National Institutes of Health and the Joseph and Ann Matella Fund for Pancreatic Cancer Research (JGT).

Funding

This study was not sponsored.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA

    Andrea N. Riner MD, MPH & Kelly M. Herremans MD

  2. Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA

    Jose G. Trevino MD & Stephen P. Sharp MD

  3. Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA

    Xiaoyan Deng MS & Dipankar Bandyopadhyay PhD

  4. Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA

    Steven D. Wexner MD, PhD

  5. Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA

    Xiaoyan Deng MS, Dipankar Bandyopadhyay PhD & Jose G. Trevino MD

Authors
  1. Andrea N. Riner MD, MPH
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  2. Kelly M. Herremans MD
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  3. Xiaoyan Deng MS
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  4. Dipankar Bandyopadhyay PhD
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  5. Steven D. Wexner MD, PhD
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  6. Jose G. Trevino MD
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  7. Stephen P. Sharp MD
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Corresponding author

Correspondence to Stephen P. Sharp MD.

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Riner, A.N., Herremans, K.M., Deng, X. et al. Racial/Ethnic Disparities in the Era of Minimally Invasive Surgery for Treatment of Colorectal Cancer. Ann Surg Oncol 30, 6748–6759 (2023). https://doi.org/10.1245/s10434-023-13693-z

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  • DOI: https://doi.org/10.1245/s10434-023-13693-z

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