Regional and patient characteristic disparities in the outcomes of minimally invasive surgery for colorectal cancer in Japan

Abstract

Aim

The use of minimally invasive surgery, including laparoscopic and robotic surgery, for gastrointestinal cancer has been rapidly increasing. This study aimed to clarify whether differences in minimally invasive surgery outcomes are associated with regional and patient characteristics.

Methods

A total of 123 771 right hemicolectomy and 126 965 low anterior resection cases performed between 2013 and 2019 were selected from the National Clinical Database for analysis. Patients were stratified by regional and economic variables, and open and minimally invasive surgical outcomes were evaluated.

Results

In secondary medical regions characterized by urban settings and numerous designated cancer care hospitals, the observed 30-day mortality of low anterior resections was lower only in the minimally invasive surgery group. For right hemicolectomies in regions with many designated cancer care hospitals, the observed incidence of postoperative complications was also lower in the minimally invasive group. Residents of high-income areas undergoing low anterior resection had a lower frequency of 30-day reoperation regardless of the type of surgery and a lower 30-day mortality in the minimally invasive group. For both right hemicolectomy and low anterior resection, patients with longer travel distances had fewer postoperative complications and lower 30-day reoperation rates in the minimally invasive group than in the open surgery group.

Conclusion

This study found regional and patient characteristic disparities in minimally invasive surgical outcomes; national policies should be implemented to address these inequities.