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Dis Colon Rectum. 2012 May;55(5):501-8. doi: 10.1097/DCR.0b013e318249ce5a.

Laparoscopic colectomy for the treatment of cancer has been widely adopted in the United States.

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1
Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA. justin.p.fox@yale.edu

Abstract

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.

Comment in

PMID:
22513427
DOI:
10.1097/DCR.0b013e318249ce5a
[Indexed for MEDLINE]
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