Cross-specialty impact in the adoption of minimally invasive surgery in abdominal surgical oncology at the hospital level.

Abstract

Colorectal surgeons have been early adopters of MIS. The objective of this study was to evaluate whether use of minimally invasive surgery (MIS) for colorectal cancers (CRC) has had an impact on use of MIS for hepatic, pancreatic, biliary, and gastric cancer (HPB/gastric) at the hospital level. We hypothesized that there is cross-specialty, hospital-level impact between colorectal and HPB/gastric surgeons in their use of MIS. Using the 2010-2019 National Cancer Database, we identified patients with histologically confirmed cancers who underwent curative-intent surgery. The hospital-level use of MIS for CRC and HPB/gastric cancers was standardized by adjusting hospital and patient covariates. Using these adjusted MIS rates as covariates, the yearly-level odds of receiving MIS for HPB/gastric cancers were estimated using logistic regression models. 87,241 and 134,019 patients (median age 65 years) with HPB/gastric cancers and CRC, respectively, were included. The proportion of hospitals performing more than 50% of their cases via MIS for both groups of cancers increased from 1% in 2010 to 27% in 2019. The proportion of hospitals performing more than 10% of their cases via a robotic approach increased from 1 to 33%. The odds of receiving MIS among patients with HPB/gastric cancers were more strongly associated with the level of MIS use for HPB/gastric cancer in the previous year than with MIS use for CRC. Adoption of MIS for HPB/gastric cancers appears to be influenced to a greater degree by intra-specialty factors rather than by cross-specialty use of MIS for CRC.