eP214 - Disparities in the Use of Robotic-Assisted Proctectomy in Rectal Cancer

Purpose/Background: Robotic-assisted surgery in surgical oncology has increased during the last decade. Rectal cancer surgery is known as being technically demanding, especially in male patients with narrow pelvises and increased body mass index. The present study aimed to identify factors associated with robotic-assisted proctectomy in rectal cancer.Methods/Interventions: This retrospective cohort study included patients with clinical stage I-III rectal adenocarcinoma who underwent proctectomy from the US National Cancer Database (2010-2019). Univariable and multivariable binary logistic regression analyses were conducted to determine the predictive factors of using robotic-assisted proctectomy in rectal cancer. The main outcome measures were actors independently associated with increased likelihood of using robotic-assisted surgery in rectal cancer.Results/Outcomes: 67,145 patients with rectal cancer who underwent proctectomy were included. 50.7% of patients were diagnosed between 2010 and 2014 and 49.3% between 2015 and 2019. 40,896 (60.9%) of patients were male with a mean age of 61.15±12.49 years. Most patients (44.7%) had stage III whereas 22.6% had stage I and 32.6% had stage II disease. Neoadjuvant radiation was given to 66.2% of patients. The surgical approach was laparotomy (n=29,725), laparoscopy (n=21,657), and robotic-assisted (n=15,763). Low anterior resection accounted for 67% and abdominoperineal resection for 22.1% of procedures performed, whereas pelvic exenteration was performed in 2.8% of patients. Factors independently associated with the use of robotic-assisted proctectomy were age < 50 years (OR: 1.06, p=0.032), male sex (OR: 1.07, p < 0.001), Asian race (OR: 1.25, p < 0.001), private insurance (OR: 1.25, p < 0.001), receiving rectal cancer treatment between 2015 and 2019 (OR: 3.52, p < 0.001), stage III disease (OR: 1.06, p=0.048), neoadjuvant radiation (OR: 1.26, p < 0.001), and pull-through coloanal anastomosis (OR: 1.15, p < 0.001). Conversely, robotic-assisted surgery was less often used in Black (OR: 0.857, p < 0.001) and American-Indian patients (OR: 0.62, p=0.002), those with a Charlson score of 3 (OR: 0.818, p=0.002), living in rural areas (OR: 0.865, p=0.033), without insurance (OR: 0.611, p < 0.001), and undergoing pelvic exenteration (OR: 0.461, p < 0.001). Limitations included the study’s retrospective nature that is associated with selection bias, only CoC-accredited hospitals were included in the analysis, and some factors that may have affected the outcome, such as body mass index, were not accounted for in the model used.Conclusion/

Discussion: Demographic disparities in the use of robotic-assisted proctectomy have been noted as Black and American Indian patients, patients with a higher Charlson comorbidity index score, and patients without insurance were less likely to undergo robotic-assisted proctectomy. Moreover, while patients with advanced disease stage and/or received neoadjuvant radiation were more likely to undergo robotic-assisted proctectomy, robotic-assisted surgery was less often performed in more extensive resections such as pelvic exenteration. This obvious disparity in resource allocation needs to be rectified and the data suggesting superior outcomes must be interpreted in the context of potential case selection bias.