eP420 - Surgical Resection vs Endoscopic Excision for Colon Carcinoma In-Situ: The Impact of Patient and Socioeconomic Factors on Management

Sunday, June 2, 2024

1:57 PM – 2:02 PM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Jacob M. Broome, MD

Resident Physician
Medstar Georgetown Washington Hospital Center
Georgetown Washington Hospital Center
20009, DC, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Timothy J. Holleran, MD

Resident Physician
MedStar Georgetown University Hospital
Washington, DC, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
Mariana Tumminello, MD

Resident Physician
Medstar Georgetown Washington Hospital Center
MedStar Georgetown/Washington Hospital Center
Washington, DC, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Jacob Neary, MD, MS

Resident
MedStar Georgetown University - MedStar Washington Hospital Center
Medstar Washington Hospital Center-Georgetown University Hospital
Washington, DC, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Majed El Hechi, MD

Resident Physician
MedStar Georgetown University Hospital
MedStar Georgetown University Hospital
Washington, DC, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
AA

Anyelin Almanzar, MD

Fellow
Washington Hospital Center
Washington, District of Columbia, United States

Disclosure information not submitted.
ET

Erin Teeple, MD

Faculty
Children's National Medical Center
Washington, District of Columbia, United States

Disclosure information not submitted.
PA

Preetha Ali, MD

Colon & Rectal Surgeon
Medstar Washington Hospital Center
Washington, District of Columbia, United States

Disclosure information not submitted.
SB

Sara Berkey, MD

Colon and Rectal Surgeon
Medstar Health
Washington, District of Columbia, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
AF

Anne Fabrizio, MD

Colorectal Surgeon
Medstar Georgetown University Hospital
Washington, District of Columbia, United States

Disclosure information not submitted.
Brian L. Bello, MD

Division Chief
Department of Colon & Rectal Surgery, MedStar Washington Hospital Center
MedStar Washington Hospital Center
Washington, District of Columbia, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

ZS

Zhifei Sun, MD

Assistant Professor of Surgery
MedStar Georgetown University Hospital
Falls Church, Virginia, United States

Disclosure information not submitted.

Purpose/Background: Despite the availability of endoscopic therapy, surgery for non-malignant colorectal polyps is common and has significantly increased over the last two decades. For those that undergo surgery for non-malignant colorectal polyps, one in seven patients will have at least one major post-operative event. Compared with surgical resection, endoscopic resection is associated with a reduced risk of adverse events. Our objective was to identify patient and socioeconomic factors that impact the odds of surgical resection versus endoscopic excision for colon carcinoma in-situ.Methods/Interventions: A retrospective review of the National Cancer Database (NCDB) was conducted from years 2004-2020. Patients with colon masses less than or equal to 2cm that were TNM stage 0 (carcinoma in-situ) and underwent surgical resection or endoscopic excision were included. Patients with TNM staging>0, mass size > 2cm, missing staging, or missing management information were excluded. Group comparison was conducted via chi-square and Mann-Whitney U when appropriate. Multivariate logistic regression was used to determine the impact of socioeconomic factors on surgical resection versus endoscopic excision.Results/Outcomes: A total of 30,541 were entered into the NCDB with carcinoma in-situ and met inclusion criteria. Of this total, 49.6% (15,152) underwent endoscopic excision and 50.4% (15,389) underwent surgical resection. When compared to endoscopic excision, the resection group was older (66 vs 68 years, p < 0.001), more likely to identify as white (79.6% vs 81.6%, p < 0.001), identify as female (42.9% vs 48.5%, p < 0.001), and travel further for treatment (14 miles vs 19 miles, p < 0.001). Additionally, the resection group was more likely to go to a non-NCI facility (75.9% vs 76.9%, p=0.043), have Medicare/Medicaid or be uninsured (60.2% vs 63.8%, p < 0.001), have a household income < $48,000 (43.2% vs 45.6%, p < 0.001), and live in a zip code with less than 13% of the population having a high school diploma (46.0% vs 47.7%, p < 0.001). 30-day unplanned hospital readmission (2.1% vs 5.7%, p < 0.001), 30-day mortality (1.0% vs 2.7%, p < 0.001), and 90-day mortality (2.6% vs 5.1%, p < 0.001) were higher in the surgical excision group. In a multivariate model, identifying as female was the strongest predictor of surgical excision (OR 1.24, CI95% 1.19-1.30, p < 0.001). Older age, identifying as white, household income < $48,000, increased distance to treatment facility, and non-NCI facility designation also significantly increased odds of surgical resection. Insurance type and percentage of high school graduates in the patient’s zip code had no significant impact.Conclusion/

Discussion: Despite statistically significant differences in socioeconomic factors between patients undergoing surgical resection versus endoscopic excision, these differences may not represent a clinical significance. The difference in unplanned readmission, 30-mortality, and 90-day mortality in this patient population may demonstrate that patients with masses less than or equal to 2 cm should be referred to tertiary centers and attempt made at endoscopic excision before surgery.