• Justin Fox, Cary P Gross, Walter Longo, and Vikram Reddy.
• Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA. justin.p.fox@yale.edu
• Dis. Colon Rectum. 2012 May 1; 55 (5): 501-8.

BackgroundFewer than 10% of patients with colon cancer in the United States are reportedly treated with a laparoscopic colectomy despite the benefits it has over the open approach. This estimate, however, may be artificially low because of inaccurate case identification.ObjectiveThe aim of this study was to estimate the proportion of colon resections performed laparoscopically for the treatment of colon cancer and to identify factors associated with its use.DesignThis study is a retrospective review of the 2008 to 2009 Nationwide Inpatient Sample. SETTINGS, PATIENTS, INTERVENTIONS: Adult patients with a diagnosis of colon cancer who underwent an elective colectomy were included.Main Outcome MeasuresThe overall proportion of colon resections performed laparoscopically was calculated. Multivariable regression modeling was used to identify patient and hospital characteristics associated with undergoing a laparoscopic procedure.ResultsDuring the study period, 9075 (weighted = 45,549) patients were identified with 50% treated via the laparoscopic approach. Patients were more likely to undergo a laparoscopic procedure if their median annual income was $63,000+ based on home zip code (adjusted relative risk = 1.08 (1.02-1.16)) and less likely if they were 70+ years of age (adjusted relative risk = 0.93 (0.87-1.00)), female (adjusted relative risk = 0.96 (0.92-0.99)), and had Medicaid (adjusted relative risk =0.84 (0.73-0.97)), or 3+ chronic conditions (adjusted relative risk = 0.84 (0.79-0.89)). Treatment at teaching hospitals (adjusted relative risk =1.10 (1.00-1.20)) and high-volume centers (adjusted relative risk =1.41 (1.22-1.63)) was associated with undergoing a laparoscopic colectomy, whereas treatment at rural hospitals was associated with less frequent use of laparoscopic colectomy (adjusted relative risk = 0.76 (0.64-0.90)).LimitationsThis study is subject to the limitations of using administrative data.ConclusionsThere has been widespread adoption of the laparoscopic approach to colon resection for cancer in the United States. Disparities in access remain, with application of this technique favoring patients with a higher socioeconomic status and those able to be treated at higher-volume, academic, and nonrural centers.

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