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Area of Science:

  • Oncology
  • Surgical Innovation
  • Health Equity

Background:

  • The adoption of robotic surgery for colorectal cancer is growing.
  • The high cost of robotic platforms may hinder widespread access.
  • This study investigates potential disparities in minimally invasive surgery (MIS) access based on patient insurance.

Purpose of the Study:

  • To examine the impact of patient insurance on the adoption of robotic colorectal cancer surgery.
  • To identify emerging inequities in access to minimally invasive surgical approaches.

Main Methods:

  • Cross-sectional analysis of stage I-III colorectal cancer cases (2010-2019) from the National Cancer Database (NCDB).
  • Primary outcome: surgical approach (robotic, laparoscopic, MIS). Predictor: patient's primary payor.
  • Multivariable models and sensitivity analyses were used to control for confounders.

Main Results:

  • Minimally invasive surgery (MIS) for colorectal cancer increased from 39% to 73% (2010-2019), with robotic approach rising from 2% to 24%.
  • Disparities in robotic approach access widened for patients with Medicaid and the uninsured compared to privately insured patients.
  • Adjusted analyses showed lower odds of robotic surgery for Medicaid (OR 0.86) and uninsured (OR 0.67) patients.

Conclusions:

  • The shift towards robotic colorectal cancer surgery is creating new inequities based on patient insurance.
  • Urgent interventions are required to ensure equitable access to robotic and other minimally invasive surgical techniques for all patients.