Abstract
Limited data are available for the epidemiology and outcome of colorectal cancer in relation to the three main surgical treatment modalities (open, laparoscopic and robotic). Using the US National Inpatient Sample database from 2004 to 2012, we identified 1,265,684 hospitalized colorectal cancer patients. Over the 9 year period, there was a 13.5% decrease in the number of hospital admissions and a 43.5% decrease in in-hospital mortality. Comparing the trend of surgical modalities, there was a 35.4% decrease in open surgeries, a 3.5 fold increase in laparoscopic surgeries, and a 41.3 fold increase in robotic surgeries. Nonetheless, in 2012, open surgery still remained the preferred surgical treatment modality (65.4%), followed by laparoscopic (31.2%) and robotic surgeries (3.4%). Laparoscopic and robotic surgeries were associated with lower in-hospital mortality, fewer complications, and shorter length of stays, which might be explained by the elective nature of surgery and earlier tumor grades. After excluding patients with advanced tumor grades, laparoscopic surgery was still associated with better outcomes and lower costs than open surgery. On the contrary, robotic surgery was associated with the highest costs, without substantial outcome benefits over laparoscopic surgery. More studies are required to clarify the cost-effectiveness of robotic surgery.
Highlights
Surgery is the most common treatment for resectable colorectal cancer, and during the last decade, it has experienced some major improvements on pre-operative assessment, instrument, surgical techniques, intra-operative monitor and post-operative care
The introduction of robot-assisted surgery improves on the limitation of laparoscopy surgery by allowing better vision, precision and, dexterity of movement[21,22,23]
We are interested in giving a comprehensive epidemiology overview of colorectal cancer admission in the United States from 2004 through 2012
Summary
Surgery is the most common treatment for resectable colorectal cancer, and during the last decade, it has experienced some major improvements on pre-operative assessment, instrument, surgical techniques, intra-operative monitor and post-operative care. The introduction of robot-assisted surgery improves on the limitation of laparoscopy surgery by allowing better vision, precision and, dexterity of movement[21,22,23]. There are still limited nation-wide studies on the comparisons between laparoscopic and robotic surgeries, as specific ICD9-CM codes for these procedures were only introduced in 2008. As far as we were aware of, most of the epidemiology data on colorectal cancer came from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program registries. SEER Program registries collect data from 18 geographic areas across the United States and is not a true nation-wide data. We are interested in giving a comprehensive epidemiology overview of colorectal cancer admission in the United States from 2004 through 2012
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