Laparoscopic colon resection. Is it being utilized?

Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
Advances in Surgery 12/2013; 47(1):29-43. DOI: 10.1016/j.yasu.2013.02.003
Source: PubMed


Since its inception, the use of laparoscopy for colon surgery has slowly increased, albeit at a slower rate than for cholecystectomy. Initial concerns about the safety and efficacy of laparoscopy have been addressed, and it is now known to have several potential short-term and long-term benefits for the patient. Early studies likely underestimated use of laparoscopy because of coding error. Currently, 40% to 50% of colectomies in the United States are performed laparoscopically, with a 10% to 20% rate of conversion to an open operation. The definitions oflaparoscopy and conversion to open remain at the discretion of the surgeons and their coders. Disparities still exist among use based on several patient, hospital, and surgeon factors. In the future, we will likely see a continuing increase in use as the new generation of surgeons enters practice, and there will be an increasing role for laparoscopy in rectal surgery. The benefit and extent of robotic surgery, natural orifice surgery, and single-incision surgery for minimally invasive colectomies are yet to be defined.

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    ABSTRACT: Advances in medical technology are changing surgical standards for colon cancer treatment. The laparoscopic colectomy is equivalent to the standard open colectomy while providing additional benefits. It is currently unknown what factors influence utilization of laparoscopic surgery in rural areas and if treatment disparities exist. The objectives of this study were to examine demographic and clinical characteristics associated with receiving laparoscopic colectomy and to examine the differences between rural and urban patients who received either procedure. This study utilized a linked data set of Nebraska Cancer Registry and hospital discharge data on colon cancer patients diagnosed and treated in the entire state of Nebraska from 2008 to 2011 (N = 1,062). Multiple logistic regression analysis was performed to identify predictors of receiving the laparoscopic treatment. Rural colon cancer patients were 40% less likely to receive laparoscopic colectomy compared to urban patients. Independent predictors of receiving laparoscopic colectomy were younger age (<60), urban residence, ≥3 comorbidities, elective admission, smaller tumor size, and early stage at diagnosis. Additionally, rural patients varied demographically compared to urban patients. Laparoscopic surgery is becoming the new standard of treatment for colon cancer and important disparities exist for rural cancer patients in accessing the specialized treatment. As cancer treatment becomes more specialized, the importance of training and placement of general surgeons in rural communities must be a priority for health care planning and professional training institutions. © 2015 National Rural Health Association.
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