National disparities in minimally invasive surgery for rectal cancer.
National disparities in minimally invasive surgery for rectal cancer.
复制标题
DOI：
10.1007/s00464-015-4296-5
复制
发表时间：
2016-03
期刊：
影响因子：
--
通讯作者：
Nurkin SJ
中科院分区：
文献类型：
--
作者：
Gabriel E;Thirunavukarasu P;Al-Sukhni E;Attwood K;Nurkin SJ
社会和种族差异已被确定为导致结直肠癌患者获得护理和肿瘤预后差异的因素。本研究的目的是调查不同种族、社会经济和地域的直肠癌患者在腹腔镜和机器人微创手术（MIS）方面的国家差异。我们利用美国外科医师学会国家癌症数据库来识别2004年至2011年期间通过开放、腹腔镜或机器人方式接受明确外科手术的直肠癌患者。纳入标准仅包括一种恶性肿瘤，无辅助治疗。进行多变量分析以调查与手术入路相关的年龄、性别、种族、收入、教育程度、保险范围、地理环境和医院类型的差异。共发现8633例患者。最初的手术方式包括46.5%的开放手术（4016例），50.9%的腹腔镜手术（4393例）和2.6%的机器人手术（224例）。在评估保险覆盖类型时，私人保险的患者最有可能接受腹腔镜手术[OR（比值比）1.637,95% CI 1.178-2.275]，尽管与机器人手术的关联不太具有统计学意义（OR 2.167, 95% CI 0.663-7.087）。收入超过46,000美元并在学术中心接受治疗的患者更有可能接受MIS（腹腔镜或机器人）。种族、教育程度和地理环境对直肠癌患者的手术入路没有统计学意义。直肠癌的微创入路约占未接受辅助治疗的患者手术的53%。机器人技术与那些收入较高、有私人保险、在学术中心接受手术的患者联系在一起。
Social and racial disparities have been identified as factors contributing to differences in access to care and oncologic outcomes in patients with colorectal cancer. The aim of this study was to investigate national disparities in minimally invasive surgery (MIS), both laparoscopic and robotic, across different racial, socioeconomic and geographic populations of patients with rectal cancer. We utilized the American College of Surgeons National Cancer Database to identify patients with rectal cancer from 2004 to 2011 who had undergone definitive surgical procedures through either an open, laparoscopic or robotic approach. Inclusion criteria included only one malignancy and no adjuvant therapy. Multivariate analysis was performed to investigate differences in age, gender, race, income, education, insurance coverage, geographic setting and hospital type in relation to the surgical approach. A total of 8633 patients were identified. The initial surgical approach included 46.5 % open (4016), 50.9 % laparoscopic (4393) and 2.6 % robotic (224). In evaluating type of insurance coverage, patients with private insurance were most likely to undergo laparoscopic surgery [OR (odds ratio) 1.637, 95 % CI 1.178–2.275], although there was a less statistically significant association with robotic surgery (OR 2.167, 95 % CI 0.663–7.087). Patients who had incomes greater than $46,000 and received treatment at an academic center were more likely to undergo MIS (either laparoscopic or robotic). Race, education and geographic setting were not statistically significant characteristics for surgical approach in patients with rectal cancer. Minimally invasive approaches for rectal cancer comprise approximately 53 % of surgical procedures in patients not treated with adjuvant therapy. Robotics is associated with patients who have higher incomes and private insurance and undergo surgery in academic centers.