13.02 Insurance Status, Not Race, is Associated with Use of Minimally Invasive Approach for Rectal Cancer

Posted on January 18, 2016

M. C. Turner1, M. A. Adam1, Z. Sun1, J. Kim1, B. Ezekian1, C. Mantyh1, J. Migaly1 1Duke University Medical Center,Surgery,Durham, NC, USA

Introduction:
Minimally invasive surgery (MIS) is increasingly utilized in rectal resection for adenocarcinoma given the superior short-term and equivalent oncologic outcomes. Race and socioeconomic status have been implicated in disparities of rectal cancer treatment and resection. Our aim was to determine the impact of patient race and medical insurance on use of minimally invasive (MIS) compared to open techniques for rectal cancer resections in the United States.

Methods:
Adult patients undergoing MIS rectal resections (laparoscopic or robotic) for stage I-III rectal adenocarcinoma were included from the National Cancer Data Base (2010-2012). Multivariate analyses were employed to identify factors independently associated with use of MIS vs. open resection.

Results:

A total of 23,274 patients were included: 9,164 (39%) underwent MIS and 14,110 (61%) open surgery. Overall, 86% were white, 8% black, 3% Asian, and 2% identified as ‘other.’ In unadjusted analysis, factors associated with use of open vs. MIS were black race, Medicare/Medicaid insurance, and lack of medical insurance. However, after adjustment for patient demographic, clinical, and treatment characteristics, black race was not associated with use of MIS vs. open surgery (OR 0.90, p=0.07). With adjustment, compared to privately insured patients, uninsured patients (OR 0.52, p<0.01) and those with Medicare/Medicaid (OR 0.79, p<0.01) were less likely to receive minimally invasive resections. Lack of insurance was significantly associated with less frequent use of MIS (OR 0.59, p=0.02) in black patients and (OR 0.51, p<0.01) in white patients. Across all uninsured patients, black race was not associated with lower frequency of MIS approach (OR 0.96, p=0.59).

Conclusion:

Medical insurance status, not race, is associated with utilization of minimally invasive techniques for oncologic rectal resections. In light of the short term benefits and cost-effectiveness, strategies to improve access to minimally invasive techniques in this patient population should be oriented toward expanding insurance coverage.