U. P. Nag1, M. Adam1, C. T. Ong1, Z. Sun1, J. Kim1, J. Migaly1, C. Mantyh1 1Duke University Medical Center,Surgery,Durham, NC, USA
Introduction: While a minimally invasive approach is associated with improved short-term outcomes and equivalent oncologic outcomes, this may not be generalizable across hospital types. This study is designed to evaluate impact of hospital type on differences in short-term and oncologic outcomes between minimally invasive segmental colectomy (MIS) and open surgery.
Methods: Adult patients undergoing segmental colectomy for non-metastatic colon adenocarcinoma were identified from the 2010-2012 National Cancer Data Base. Descriptive statistics were used to characterize patterns of MIS (laparoscopic or robotic) vs. open colectomy by hospital type. Multivariable models were used to examine the effect of hospital type on short-term and oncologic outcomes from MIS vs. open surgery while adjusting for patient, clinical, and tumor characteristics.
Results: A total of 97,620 patients underwent segmental colectomy for cancer: 44,027 (45%) underwent MIS, and 53.593 (55%) underwent open surgery. Overall, 25% of cases were performed at academic, 60% comprehensive community, and 15% community centers. MIS was more often utilized at comprehensive community (61%) and academic centers (27%) than community centers (12%). Compared to open surgery, the MIS group was more likely to have a complete tumor resection, shorter length of stay, lower 30-day mortality, and better overall survival regardless of institution type (all p < 0.01). Length of stay was significantly shorter by 1 day in the MIS vs. open group across all hospital types (all p<0.01), without increased 30-day readmissions. MIS was significantly associated with lower 30-day mortality, which was similar across hospital types: academic [OR 0.51 (CI 0.41-0.64), p<0.01], comprehensive community [OR 0.56 (CI 0.49-0.63), p<0.01], and community [OR 0.45 (CI 0.34-0.61), p<0.01]. Overall survival benefit was also comparable throughout hospital types: academic [hazard ratio (HR) 0.71 (CI 0.69-0.76, p<0.01], comprehensive community [HR 0.73 (CI 0.69-0.78), p<0.01], and community [HR 0.72 (CI 0.63-0.810, p<0.01].
Conclusion: Minimally invasive segmental colectomy is associated with superior perioperative outcomes and lower 30-day mortality. Although hospital type may impact outcomes of other procedures, the benefits of minimally invasive techniques were observed across hospital types. Utilization of laparoscopy and robotic surgery may be variable across hospitals, but wider dissemination of minimally invasive techniques should be emphasized for colon cancer.