R. Jindani1, J. Rodriguez-Quintero1, M. Kamel2, M. Vimolratana1, N. P. Chudgar1, B. M. Stiles1 1Montefiore Medical Center/ Albert Einstein College Of Medicine, Department Of Cardiothoracic Surgery, Bronx, NY, USA 2University Of Rochester Medical Center, Department Of Cardiothoracic Surgery, Rochester, NY, USA
Introduction:
Robotic surgery has become an increasingly utilized approach for resectable lung cancers. However, accessibility to robotics may be limited in certain patient populations, creating inequity in the adoption and administration of this surgical technique. We hypothesize that the rising use of robotic surgery could contribute to disparities in surgical care for resectable non-small cell lung cancer (NSCLC).
Methods:
We queried the National Cancer Database (NCDB) for patients with clinical stage I-III NSCLC who underwent surgical intervention, stratifying the cohort based on surgical technique (2010-2019). The Mantel-Haenszel test of trend was used to assess the rates of robotic surgery over time. Multivariable logistic regression analysis was performed to identify associations between sociodemographic factors and the robotic (vs. thoracoscopic and open) approach.
Results:
Among 226,455 clinical stage I-III NSCLC patients who underwent surgical intervention from 2010-2019, 34,059 (15%) received robotic resections, 78,039 (34.5%) received thoracoscopic resections, and 114,357 (50.5%) received open resections. Robotic surgery utilization increased throughout the past decade, from 3.1% in 2010 to 34% in 2019. By the end of the study period, the number of robotic cases was nearing the number of thoracoscopic cases and overtook the number of open cases occurring per year (Figure 1). Despite this, multivariable analysis revealed that male sex (aOR 0.96, 95%CI 0.93-0.98), urban and rural settings (urban aOR 0.98, 95%CI 0.77-0.85; rural aOR 0.59, 95%CI 0.53-0.66), lack of insurance (aOR 0.81, 95%CI 0.72-0.91), treatment at community centers (comprehensive community cancer programs aOR 0.73, 95%CI 0.70-0.75; community cancer programs aOR 0.49, 95%CI 0.46-0.54), lower income brackets (aOR 0.93, 95%CI 0.90-0.95), and certain geographic regions were associated with underutilization of robotic surgery after adjusting by clinical stage.
Conclusion:
The utilization of robotic surgery, in comparison to thoracoscopic or open approaches, reveals significant socioeconomic disparities across patient demographics, insurance status, median income, location, and facility type. Identifying these gaps in care is crucial for promoting equality and uniformity in surgical treatment.
