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National Utilization of Minimally Invasive Surgery for Rectal Cancer
*Allyson H Stone, Samuel R.g. Finlayson, *Stefan D. Holubar Dartmouth-Hitchcock Medical Center, Lebanon, NH
Objective: Examine recent nationwide trends in the adoption of minimally invasive surgical techniques for elective resections for rectal cancer since 2004. Design: Retrospective review. Setting: Hospitals participating in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Patients: Adults (18 to 99) diagnosed with rectal cancer (ICD-9 code 154.1) who underwent elective rectal resection between January 1, 2005 and December 31, 2009. Interventions: We used the National Inpatient Sample to estimate national procedure totals and calculated proportions of minimally invasive procedures performed, stratified by procedure type, hospital characteristics, and geographic region. Pearson chi square tests were used to assess the statistical significance of trends observed over time. Main Outcome Measures: Recent trends in adoption of laparoscopy for elective resection of rectal cancer. Results: From 2005 to 2009, the proportion of elective resections performed laparoscopically increased from 3.3% to 12.1%. This rise was greatest for APR (2.3% to 20.8%, p<0.0001) and least for LAR with anastamosis (3.9% to 6.8%, p<0.001). Use of laparoscopy for LAR with synchronous colostomy did not change significantly over time (3.6% to 3.4%, p=0.97). The proportion of procedures performed laparoscopically increased over time in all geographic regions and for all hospital types (Table 1). Conclusions: There has been a significant rise in use of laparoscopy for elective resection of rectal cancer since 2005, a trend pronounced most with APR and least with LAR.
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