• Megan Turner, Mohamed Abdelgadir Adam, Zhifei Sun, Jina Kim, Brian Ezekian, Babatunde Yerokun, Christopher Mantyh, and John Migaly.
• Department of Surgery, Duke University Medical Center, Durham, NC.
• Ann. Surg. 2017 Apr 1; 265 (4): 774-781.

ObjectiveTo determine the impact of race and insurance on use of minimally invasive (MIS) compared with open techniques for rectal cancer in the United States.BackgroundRace and socioeconomic status have been implicated in disparities of rectal cancer treatment.MethodsAdults undergoing MIS (laparoscopic or robotic) or open rectal resections for stage I to III rectal adenocarcinoma were included from the National Cancer Database (2010-2012). Multivariate analyses were employed to examine the adjusted association of race and insurance with use of MIS versus open surgery.ResultsAmong 23,274 patients, 39% underwent MIS and 61% open surgery. Overall, 86% were white, 8% black, and 3% Asian. Factors associated with use of open versus MIS were black race, Medicare/Medicaid insurance, and lack of insurance. However, after adjustment for patient demographic, clinical, and treatment characteristics, black race was not associated with use of MIS versus open surgery [odds ratio [OR] 0.90, P = 0.07). Compared with 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 use of MIS in black (OR 0.59, P = 0.02) or white patients (OR 0.51, P < 0.01). However, among uninsured patients, black race was not associated with lower use of MIS (OR 0.96, P = 0.59).ConclusionsInsurance status, not race, is associated with utilization of minimally invasive techniques for oncologic rectal resections. Due to the short-term benefits and cost-effectiveness of minimally invasive techniques, hospitals may need to improve access to these techniques, especially for uninsured patients.

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