In an English population–based study reported in The Lancet Oncology, Maringe et al found that inequalities in provision of minimally invasive surgical resection of colon cancer may be associated with poorer patient outcomes.
Study Details
The study involved data from patients diagnosed with stage I to III colon carcinoma between January and December 2022 who underwent elective resection at National Health Service Trust facilities in England. Use of minimally invasive resection was analyzed according to four suboptimal uptake groups: those aged 65 years and older, frail individuals, those with comorbidities, and those with high levels of socioeconomic deprivation.
Key Findings
The analysis included 10,603 patients undergoing open or minimally invasive resection. Median follow-up was 1.47 years (interquartile range = 1.22–1.74 years); mean age at diagnosis was 70.3 years; and 51.7% of patients were male.
Minimally invasive resection was attempted in 8,909 patients (84.0%) and completed in 7,951 (75.0%); open resection was completed in 2,652 patients. Inequalities in the proportion of minimally invasive surgical resections were observed for diagnosis at age ≥ 65 vs < 65 years (73.8% vs 77.8%); moderate/high frailty score vs low frailty score (64.1% vs 76.2%); comorbidities vs no comorbidities (70.8% vs 76.9%); and most deprived vs least deprived quintiles (73.9% vs 76.2%).
Patients who underwent minimally invasive surgical resection had 3- to 4-day shorter lengths of hospital stay vs those who underwent open surgical resection. They also had reduced 30-day readmission rates (13.1% vs 18.1%) and 1-year mortality rates (2.9% vs 7.9%).
Analysis correcting for inequalities in provision of minimally invasive surgical resection resulted in reductions in total hospital stay of 1,567, 975, 912, and 682 days for the age, deprivation, comorbidity, and frailty categories, respectively, and reductions in 1-year mortality (14, 9, 8, and 6 fewer deaths) in the entire cohort.
The investigators concluded: “Correcting inequalities in implementation of minimally invasive surgical resection has the potential to reduce inequalities in colon cancer outcomes.”
Camille Maringe, PhD, of the Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, is the corresponding author for The Lancet Oncology article.
DISCLOSURE: The study was funded by Cancer Research UK. For full disclosures of the study authors, visit thelancet.com.
