Racial disparities in access to minimally invasive proctectomy for rectal cancer-a National Surgical Quality Improvement Program study

Yosef Y Nasseri; Kristina H-T La; Kimberly Oka; Paola Solis-Pazmino; Abbas Smiley; Sean Langenfeld; Jason Cohen; Moshe Barnajian

doi:10.1111/codi.16994

Racial disparities in access to minimally invasive proctectomy for rectal cancer-a National Surgical Quality Improvement Program study

Colorectal Dis. 2024 May 3. doi: 10.1111/codi.16994. Online ahead of print.

Authors

Yosef Y Nasseri^{1

2}, Kristina H-T La², Kimberly Oka², Paola Solis-Pazmino², Abbas Smiley³, Sean Langenfeld⁴, Jason Cohen^{1

2}, Moshe Barnajian^{1

2}

Affiliations

¹ Cedars-Sinai Medical Center, Los Angeles, California, USA.
² Surgery Group of LA, Los Angeles, California, USA.
³ Westchester Medical Center Health Network, Valhalla, New York, USA.
⁴ University of Nebraska Medical Center, Omaha, Nebraska, USA.

PMID: 38702908
DOI: 10.1111/codi.16994

Abstract

Aim: The aim of this work was to determine racial disparities in access to minimally invasive proctectomy using a national database.

Method: A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program evaluated for surgical approach (robotic, laparoscopic or open), demographics and comorbidity, and then compared by race.

Results: A total of 3511 patients (325 Asian, 2925 White, 261 African American/Black) with cancer who underwent a proctectomy between 2016 and 2020 were included. Both Asians and Whites had significantly higher rates of laparoscopic proctectomy relative to African Americans (38.5%, 33.8% and 28.7%, respectively; p = 0.0001). Asians had the highest rate of robotic proctectomy (38.2%, p = 0.0001). Conversely, Black patients had significantly higher rates of open proctectomy followed by Whites and then Asians (42.1%, 35.4% and 23.4%, respectively; p = 0.0001). In multivariable logistic regression with backward elimination, African Americans were 0.7 times as likely to undergo laparoscopic proctectomy and 1.4 times more likely to undergo open proctectomy than Whites (p = 0.043). Compared with Whites, Asians were 1.8, 1.7 and 1.9 times more likely to undergo minimally invasive, laparoscopic proctectomy and robotic proctectomy, respectively (p = 0.0001, p = 0.001, p = 0.0001).

Conclusion: Asians had the highest rate of laparoscopic and robotic proctectomy, while Blacks had the highest rate of open proctectomy. African Americans were least likely to undergo laparoscopic proctectomy compared with all races. Race is an independent risk factor for access to minimally invasive proctectomy.

Keywords: Race; Racial disparities; Rectal Cancer; minimally invasive; proctectomy.