Journal article
Factors associated with access and approach to esophagectomy for cancer: a National Cancer Database study
Surgical endoscopy, v 36(9), pp 7016-7024
01 Sep 2022
PMID: 35059836
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background Minimally invasive esophagectomy (MIE) for esophageal cancer has been associated with decreased pain, less blood loss, and shorter hospital stay with comparable survival to open surgery. To date, there is minimal information regarding what factors are associated with access to MIE. Methods The National Cancer Database (NCDB) was used to compare rates of MIE (either robotic or laparoscopic) and open esophagectomy (OE) by demographic and clinical factors. Continuous variables were compared using a linear trend test, and categorical variables were compared using Mantel-Haenszel tests. Binomial regression was performed to examine significant factors after adjusting for confounding variables. Results There were 18,366 patients included in the analysis. Of all esophagectomies performed in the US, 49% were performed by OE and 51% were performed by MIE. Patients who had undergone MIE were more likely to live in the Eastern US as compared with the Midwest [odds ratio (OR) 1.72; 95% confidence interval (CI) 1.58, 1.88] or the South (OR 1.31; 95% CI 1.19, 1.44). They were also more likely to be treated at an academic center (OR 1.64; 95% CI 1.53, 1.75) rather than a community hospital, and to be of White race as compared with Asian race (OR 1.46; 95% CI 1.10, 1.92). There was not a significant difference in the rates of MIE between White and Black patients (OR 1.12; 95% CI 0.96, 1.32). MIE was more likely with each passing year, and higher TNM stages of cancer were less likely to be treated with MIE (P < 0.001 for all). Conclusion While MIE is evolving, OE is still considered standard of care with robotic approaches representing a minority of MIE. While there are several factors associated with access to MIE, including race, facility type and geographic location, these factors should be further explored to help increase access to MIE.
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Details
- Title
- Factors associated with access and approach to esophagectomy for cancer: a National Cancer Database study
- Creators
- Elizabeth Blears - Allegheny General HospitalHiran C. Fernando - Allegheny General HospitalJames Shahoud - Allegheny General HospitalBenny Weksler - Allegheny General Hospital
- Publication Details
- Surgical endoscopy, v 36(9), pp 7016-7024
- Publisher
- Springer Nature
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Medicine (Graduate); Surgery
- Web of Science ID
- WOS:000744811300005
- Scopus ID
- 2-s2.0-85123265444
- Other Identifier
- 991021960643904721
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- Web of Science research areas
- Surgery