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Incidence of minimally invasive colorectal cancer surgery at National Comprehensive Cancer Network centers
Heather Yeo1, Joyce Niland1, Dana Milne1
1Memorial Sloan Kettering Cancer Center, New York, NY (HY, MRW); City of Hope Comprehensive Cancer Center, Duarte, CA (JN, AtV, LL, DS); Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (DM, LL); The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, OH (TBS); Fox Chase Cancer Center, Philadelphia, PA (JMF); The University of Texas M.D. Anderson Cancer Center, Houston, TX (JMS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (WS Jr); Roswell Park Cancer Institute, Buffalo, NY (NW).
Background:
Laparoscopic colectomy has been shown to have equivalent oncologic outcomes to open colectomy for the management of colon cancer, but its adoption nationally has been slow. This study investigates the prevalence and factors associated with laparoscopic colorectal resection at National Comprehensive Cancer Network (NCCN) centers.
Methods:
Data on patients undergoing surgery for colon and rectal cancer at NCCN centers from 2005 to 2010 were obtained from chart review of medical records for the NCCN Outcomes Project and included information on socioeconomic status, insurance coverage, comorbidity, and physician-reported Eastern Cooperative Oncology Group (ECOG) performance status. Associations between receipt of minimally invasive surgery and patient and clinical variables were analyzed with univariate and multivariable logistic regression. All statistical tests were two-sided.
Results:
A total of 4032 patients, diagnosed between September 2005 and December 2010, underwent elective colon or rectal resection for cancer at NCCN centers. Median age of colon cancer patients was 62.6 years, and 49% were men. The percent of colon cancer patients treated with minimally invasive surgery (MIS) increased from 35% in 2006 to 51% in 2010 across all centers but varied statistically significantly between centers. On multivariable analysis, factors associated with minimally invasive surgery for colon cancer patients who had surgery at an NCCN institution were older age (P = .02), male sex (P = .006), fewer comorbidities (P ≤ .001), lower final T-stage (P < .001), median household income greater than or equal to $80000 (P < .001), ECOG performance status = 0 (P = .02), and NCCN institution (P ≤ .001).
Conclusions:
The use of MIS increased at NCCN centers. However, there was statistically significant variation in adoption of MIS technique among centers.