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Laparoscopic colectomy for the treatment of cancer has been widely adopted in the United States.
Dis Colon Rectum. 2012 May; 55(5):501-8.DC

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.

Authors+Show Affiliations

Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA. justin.p.fox@yale.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22513427

Citation

Fox, Justin, et al. "Laparoscopic Colectomy for the Treatment of Cancer Has Been Widely Adopted in the United States." Diseases of the Colon and Rectum, vol. 55, no. 5, 2012, pp. 501-8.
Fox J, Gross CP, Longo W, et al. Laparoscopic colectomy for the treatment of cancer has been widely adopted in the United States. Dis Colon Rectum. 2012;55(5):501-8.
Fox, J., Gross, C. P., Longo, W., & Reddy, V. (2012). Laparoscopic colectomy for the treatment of cancer has been widely adopted in the United States. Diseases of the Colon and Rectum, 55(5), 501-8. https://doi.org/10.1097/DCR.0b013e318249ce5a
Fox J, et al. Laparoscopic Colectomy for the Treatment of Cancer Has Been Widely Adopted in the United States. Dis Colon Rectum. 2012;55(5):501-8. PubMed PMID: 22513427.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic colectomy for the treatment of cancer has been widely adopted in the United States. AU - Fox,Justin, AU - Gross,Cary P, AU - Longo,Walter, AU - Reddy,Vikram, PY - 2012/4/20/entrez PY - 2012/4/20/pubmed PY - 2012/7/11/medline SP - 501 EP - 8 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 55 IS - 5 N2 - 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. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/22513427/Laparoscopic_colectomy_for_the_treatment_of_cancer_has_been_widely_adopted_in_the_United_States_ L2 - http://dx.doi.org/10.1097/DCR.0b013e318249ce5a DB - PRIME DP - Unbound Medicine ER -