Access to minimally invasive colon cancer surgery varies by location

Where patients live may determine whether they receive minimally invasive colon cancer surgery.

A new study finds that in some parts of the United States, approximately two-thirds of patients with colon cancer may undergo laparoscopic colectomy, a minimally invasive procedure to remove part of the colon. In other parts of the country, the rate was zero.

Colectomy is recommended for most patients with nonmetastatic colon cancer. Laparoscopic colectomy, which uses multiple small incisions and thin instruments to perform the procedure, has been shown to be equally effective for treating colon cancer. But patients undergoing laparoscopic surgery have less pain, shorter hospital stays, and faster recovery.

“Although every patient makes his or her own unique decision, most patients offered a laparoscopic colectomy will strongly consider this approach, given the benefits of minimally invasive surgery. Our study shows that these benefits may not be available to patients who live in certain regions,” said lead author Bradley N. Reames, MD, MS, a surgical resident at the University of Michigan Comprehensive Cancer Center, in Ann Arbor.

The researchers looked at Medicare claims data and tied it to hospital referral regions. They assessed 93,786 patients who underwent colectomy for colon cancer at nearly 3,500 hospitals across the country. Overall, approximately one-third of the procedures were laparoscopic. Rates ranged from a low of 0% to a high of 67%. Results appeared in the Journal of Clinical Oncology (2014; doi:10.1200/JCO.2014.57.1588).

The equipment to perform laparoscopic surgery was available at nearly every hospital, the researchers found, suggesting that it is not an infrastructure or equipment issue. Not all patients are eligible for laparoscopic surgery; however, a surgeon's comfort with the procedure is likely to influence which patients that surgeon will recommend for it.

“We believe the key issue is surgeon training or experience. Many surgeons offering this approach complete additional fellowship training in colorectal surgery or seek out opportunities to learn this approach while in practice. Those who don't are not likely to offer the approach to their patients, or they do so only to a highly specialized group of ideal, straightforward candidates,” said senior study author Scott E. Regenbogen, MD, assistant professor of surgery at the University of Michigan.

The researchers suggest that better patient education and surgeon training are both needed to reduce the geographic variation in laparoscopic colectomy.

They urge patients who are referred for colon cancer surgery to research the qualifications and training of surgeons, and understand what types of procedures the surgeon offers. Patients should inquire about a laparoscopic approach and whether they are eligible.

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