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Surgical Endoscopy

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01-07-2021 | Colorectal Cancer | 2020 SAGES Oral

Do specific operative approaches and insurance status impact timely access to colorectal cancer care?

Authors: Brian D. Lo, George Q. Zhang, Miloslawa Stem, Rebecca Sahyoun, Jonathan E. Efron, Bashar Safar, Chady Atallah

Published in: Surgical Endoscopy | Issue 7/2021

Abstract

Introduction

The increased use of minimally invasive surgery in the management of colorectal cancer has led to a renewed focus on how certain factors, such as insurance status, impact the equitable distribution of both laparoscopic and robotic surgery. Our goal was to analyze surgical wait times between robotic, laparoscopic, and open approaches, and to determine whether insurance status impacts timely access to treatment.

Methods

After IRB approval, adult patients from the National Cancer Database with a diagnosis of colorectal cancer were identified (2010–2016). Patients who underwent radiation therapy, neoadjuvant chemotherapy, had wait times of 0 days from diagnosis to surgery, or had metastatic disease were excluded. Primary outcomes were days from cancer diagnosis to surgery and days from surgery to adjuvant chemotherapy. Multivariable Poisson regression analysis was performed.

Results

Among 324,784 patients, 5.9% underwent robotic, 47.5% laparoscopic, and 46.7% open surgery. Patients undergoing robotic surgery incurred the longest wait times from diagnosis to surgery (29.5 days [robotic] vs. 21.7 [laparoscopic] vs. 17.2 [open], p < 0.001), but the shortest wait times from surgery to adjuvant chemotherapy (48.9 days [robotic] vs. 49.9 [laparoscopic] vs. 54.8 [open], p < 0.001). On adjusted analysis, robotic surgery was associated with a 1.46 × longer wait time to surgery (IRR 1.462, 95% CI 1.458–1.467, p < 0.001), but decreased wait time to adjuvant chemotherapy (IRR 0.909, 95% CI 0.905–0.913, p < 0.001) compared to an open approach. Private insurance was associated with decreased wait times to surgery (IRR 0.966, 95% CI 0.962–0.969, p < 0.001) and adjuvant chemotherapy (IRR 0.862, 95% CI 0.858–0.865, p < 0.001) compared to Medicaid.

Conclusion

Though patients undergoing robotic surgery experienced delays from diagnosis to surgery, they tended to initiate adjuvant chemotherapy sooner compared to those undergoing open or laparoscopic approaches. Private insurance was independently associated not only with access to robotic surgery, but also shorter wait times during all stages of treatment.

Graphic Abstract

Addae JK, Gani F, Fang SY, Wick EC, Althumairi AA, Efron JE, Canner JK, Euhus DM, Schneider EB (2017) A comparison of trends in operative approach and postoperative outcomes for colorectal cancer surgery. J Surg Res 208:111–120. https://doi.org/10.1016/j.jss.2016.09.019CrossRefPubMed

Lee M-TG, Chiu C-C, Wang C-C, Chang C-N, Lee S-H, Lee M, Hsu T-C, Lee C-C (2017) Trends and outcomes of surgical treatment for colorectal cancer between 2004 and 2012- an analysis using national inpatient database. Sci Rep 7:2006. https://doi.org/10.1038/s41598-017-02224-yCrossRefPubMedPubMedCentral

Bhama AR, Obias V, Welch KB, Vandewarker JF, Cleary RK (2016) A comparison of laparoscopic and robotic colorectal surgery outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Surg Endosc 30:1576–1584. https://doi.org/10.1007/s00464-015-4381-9CrossRefPubMed

Feinberg AE, Elnahas A, Bashir S, Cleghorn MC, Quereshy FA (2016) Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity. Can J Surg 59:262–267. https://doi.org/10.1503/cjs.016615CrossRefPubMedPubMedCentral

Jeong S-Y, Park JW, Nam BH, Kim S, Kang S-B, Lim S-B, Choi HS, Kim D-W, Chang HJ, Kim DY, Jung KH, Kim T-Y, Kang GH, Chie EK, Kim SY, Sohn DK, Kim D-H, Kim J-S, Lee HS, Kim JH, Oh JH (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15:767–774. https://doi.org/10.1016/S1470-2045(14)70205-0CrossRef

van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218. https://doi.org/10.1016/S1470-2045(13)70016-0CrossRef

Benlice C, Aytac E, Costedio M, Kessler H, Abbas MA, Remzi FH, Gorgun E (2017) Robotic, laparoscopic, and open colectomy: a case-matched comparison from the ACS-NSQIP. Int J Med Robot. https://doi.org/10.1002/rcs.1783CrossRefPubMed

Turner M, Adam MA, Sun Z, Kim J, Ezekian B, Yerokun B, Mantyh C, Migaly J (2017) Insurance status, not race, is associated with use of minimally invasive surgical approach for rectal cancer. Ann Surg 265:774–781. https://doi.org/10.1097/SLA.0000000000001781CrossRefPubMed

Gabriel E, Thirunavukarasu P, Al-Sukhni E, Attwood K, Nurkin SJ (2016) National disparities in minimally invasive surgery for rectal cancer. Surg Endosc 30:1060–1067. https://doi.org/10.1007/s00464-015-4296-5CrossRefPubMed

10.

Cairns AL, Schlottmann F, Strassle PD, Di Corpo M, Patti MG (2019) Racial and socioeconomic disparities in the surgical management and outcomes of patients with colorectal carcinoma. World J Surg 43:1342–1350. https://doi.org/10.1007/s00268-018-04898-5CrossRefPubMed

11.

Hao Y, Landrine H, Jemal A, Ward KC, Bayakly AR, Young JL, Flanders WD, Ward EM (2011) Race, neighbourhood characteristics and disparities in chemotherapy for colorectal cancer. J Epidemiol Commun Health 65:211–217. https://doi.org/10.1136/jech.2009.096008CrossRef

12.

Murphy CC, Harlan LC, Warren JL, Geiger AM (2015) Race and insurance differences in the receipt of adjuvant chemotherapy among patients with stage III colon cancer. J Clin Oncol 33:2530–2536. https://doi.org/10.1200/JCO.2015.61.3026CrossRefPubMedPubMedCentral

13.

National Cancer Database. https://www.facs.org/quality-programs/cancer/ncdb. Accessed 1 May 2020

14.

Davis CH, Gaglani T, Moore LW, Du XL, Hwang H, Yamal J-M, Bailey HR, Cusick MV (2019) Trends and outcomes in laparoscopic versus open surgery for rectal cancer from 2005 to 2016 using the ACS-NSQIP database, a retrospective cohort study. Int J Surg 63:71–76. https://doi.org/10.1016/j.ijsu.2019.02.006CrossRefPubMed

15.

Matsuyama T, Kinugasa Y, Nakajima Y, Kojima K (2018) Robotic-assisted surgery for rectal cancer: current state and future perspective. Ann Gastroenterol Surg 2:406–412. https://doi.org/10.1002/ags3.12202CrossRefPubMedPubMedCentral

16.

Villano AM, Zeymo A, Houlihan BK, Bayasi M, Al-Refaie WB, Chan KS (2019) Minimally invasive surgery for colorectal cancer: hospital type drives utilization and outcomes. J Surg Res. https://doi.org/10.1016/j.jss.2019.07.102CrossRefPubMed

17.

Liao G, Li Y-B, Zhao Z, Li X, Deng H, Li G (2016) Robotic-assisted surgery versus open surgery in the treatment of rectal cancer: the current evidence. Sci Rep 6:26981. https://doi.org/10.1038/srep26981CrossRefPubMedPubMedCentral

18.

Sheng S, Zhao T, Wang X (2018) Comparison of robot-assisted surgery, laparoscopic-assisted surgery, and open surgery for the treatment of colorectal cancer. Medicine (Baltimore) 97:e11817. https://doi.org/10.1097/MD.0000000000011817CrossRef

19.

Ng KT, Tsia AKV, Chong VYL (2019) Robotic versus conventional laparoscopic surgery for colorectal cancer: a systematic review and meta-analysis with trial sequential analysis. World J Surg 43:1146–1161. https://doi.org/10.1007/s00268-018-04896-7CrossRefPubMed

20.

Keller DS, Senagore AJ, Lawrence JK, Champagne BJ, Delaney CP (2014) Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection. Surg Endosc 28:212–221. https://doi.org/10.1007/s00464-013-3163-5CrossRefPubMed

21.

Park JS, Choi G-S, Park SY, Kim HJ, Ryuk JP (2012) Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg 99:1219–1226. https://doi.org/10.1002/bjs.8841CrossRefPubMed

22.

Bertani E, Chiappa A, Biffi R, Pietro BP, Radice D, Branchi V, Cenderelli E, Vetrano I, Cenciarelli S, Andreoni B (2011) Assessing appropriateness for elective colorectal cancer surgery: clinical, oncological, and quality-of-life short-term outcomes employing different treatment approaches. Int J Colorectal Dis 26:1317–1327. https://doi.org/10.1007/s00384-011-1270-0CrossRefPubMed

23.

Baek S-J, Kim S-H, Cho J-S, Shin J-W, Kim J (2012) Robotic versus conventional laparoscopic surgery for rectal cancer: a cost analysis from a single institute in Korea. World J Surg 36:2722–2729. https://doi.org/10.1007/s00268-012-1728-4CrossRefPubMed

24.

Sjo OH, Larsen S, Lunde OC, Nesbakken A (2009) Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis 11:733–739. https://doi.org/10.1111/j.1463-1318.2008.01613.xCrossRefPubMed

25.

Tevis SE, Kohlnhofer BM, Stringfield S, Foley EF, Harms BA, Heise CP, Kennedy GD (2013) Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival. Dis Colon Rectum 56:1339–1348. https://doi.org/10.1097/DCR.0b013e3182a857ebCrossRefPubMed

26.

Kim IY, Kim BR, Kim YW (2015) Factors affecting use and delay (≥8 weeks) of adjuvant chemotherapy after colorectal cancer surgery and the impact of chemotherapy-use and delay on oncologic outcomes. PLoS ONE 10:e0138720. https://doi.org/10.1371/journal.pone.0138720CrossRefPubMedPubMedCentral

Title: Do specific operative approaches and insurance status impact timely access to colorectal cancer care?
Authors: Brian D. Lo
George Q. Zhang
Miloslawa Stem
Rebecca Sahyoun
Jonathan E. Efron
Bashar Safar
Chady Atallah
Publication date: 01-07-2021
Publisher: Springer US
Keywords: Colorectal Cancer
Colorectal Cancer
Cytostatic Therapy
Published in: Surgical Endoscopy / Issue 7/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07870-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Do specific operative approaches and insurance status impact timely access to colorectal cancer care?

Abstract

Introduction

Methods

Results

Conclusion

Graphic Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Graphic Abstract

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