Education / Lap & Robotics / Surgical Innovations
Mid-Atlantic Section 76th Annual Meeting
Introduction & Objective : Minimally-invasive (robotic and laparoscopic) and open surgery for localized renal cancer offer comparable oncologic outcomes. However, the evolving trends in utilization of minimally-invasive surgery at the national level as well as the barriers preventing access to minimally-invasive surgery among specific patient populations are poorly understood.
Methods : A retrospective cohort study was conducted using the National Cancer Database to identify patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN) for cT1N0M0 renal cancer diagnosed between 2010 and 2015. Main outcomes of interest were the utilizations of minimally-invasive (robotic and laparoscopic) PN and RN.
Results : A total of 46,346 and 37,712 subjects who underwent PN and RN, respectively, were analyzed. PN and RN surgical approach distributions by year of diagnosis are shown in the Figure. During the study interval, robotic PN increased from 35.2% to 63.7% and robotic RN increased from 10.3% to 26.3%. In the PN cohort, multivariable logistic regression showed non-Hispanic black (odds ratio [OR]=0.90 [95%CI,0.84-0.96]) and Hispanic (OR=0.91 [0.84-0.99]) subjects were associated with less utilization of minimally-invasive surgery (vs. non-Hispanic white). Younger (18-64 y) Medicare (OR=0.83 [0.77-0.90]), Medicaid (OR=0.80 [0.74-0.87]), and uninsured (OR=0.55 [0.49-0.62]) were also associated with less utilization of minimally-invasive surgery (vs. private insurance). Compared with low socioeconomic status, upper middle (OR=1.14 [1.07-1.21]) and high (OR=1.24 [1.16-1.33]) socioeconomic status were associated with higher utilization of minimally-invasive surgery. Similar demographic, insurance, and socioeconomic status related disparities were identified in the RN cohort.
Conclusions : Utilization of minimally-invasive surgery for localized renal cancer has increased significantly and was mainly attributed to increased usage of robotic surgery. Racial/ethnic, insurance, and socioeconomic status related disparities in minimally-invasive surgery utilization were identified. Our findings demonstrate a targetable subgroup of patients who do not have the same access to advances in surgical technology.