Hoogerboord C Marius, Levy Adrian R, Hu Min, Flowerdew Gordon, Porter Geoffrey
Division of General Surgery (Hoogerboord, Porter), Department of Surgery, Dalhousie University; Department of Community Health and Epidemiology (Hoogerboord, Levy, Flowerdew, Porter), Dalhousie University; Department of Economics (Hu), Dalhousie University, Halifax, NS
Division of General Surgery (Hoogerboord, Porter), Department of Surgery, Dalhousie University; Department of Community Health and Epidemiology (Hoogerboord, Levy, Flowerdew, Porter), Dalhousie University; Department of Economics (Hu), Dalhousie University, Halifax, NS.
CMAJ Open. 2018 Sep 18;6(3):E384-E390. doi: 10.9778/cmajo.20180002. Print 2018 Jul-Sep.
Evidence from randomized controlled trials published since 2004 shows that elective laparoscopic colectomy for colon cancer improves short-term postoperative outcomes with equivalent oncologic outcomes compared to open colectomy. The objective of this study was to examine the uptake of elective laparoscopic colectomy in Canada and compare its use among Canadian provinces.
In this descriptive analysis, we identified from hospital discharge abstracts all patients in the Canadian provinces (except Quebec) who underwent elective colectomy for colon cancer between 2004/05 and 2014/15. We compared temporal changes in the proportion of patients who underwent laparoscopic colectomy or open colectomy among provinces using logistic regression.
Of 63 504 patients who underwent elective colectomy between 2004/05 and 2014/15, 19 691 (31.0%) underwent laparoscopic colectomy. The annual proportion of patients who underwent laparoscopic colectomy increased from 9.2% in 2004/05 to 51.5% in 2014/15 (mean annual percent increase 4.2%). There were significant differences between provinces in the overall proportion of patients who underwent laparoscopic colectomy ( < 0.001), ranging from 7.6% in Newfoundland and Labrador to 36.9% in Ontario. By 2014/15, most colectomy procedures were performed laparoscopically in 3 provinces; British Columbia (60.2%), Ontario (59.4%) and Alberta (53.1%). In addition to year and province, urban residence, younger age, female sex, fewer medical comorbidities, high surgeon volume, high hospital volume and right-sided tumours were significantly associated with increased likelihood of laparoscopic colectomy.
Although the use of laparoscopic colectomy increased rapidly between 2004/05 and 2014/15 in Canada, substantial interprovincial variation exists. Further knowledge-translation strategies are needed to ensure equal access to laparoscopic colectomy for all Canadians.
2004年以来发表的随机对照试验证据表明，与开放性结肠切除术相比，择期腹腔镜结肠癌切除术可改善术后短期预后，且肿瘤学预后相当。本研究的目的是调查加拿大择期腹腔镜结肠切除术的采用情况，并比较其在加拿大各省的使用情况。
在这项描述性分析中，我们从医院出院摘要中识别出加拿大各省（魁北克省除外）在2004/05年至2014/15年期间接受择期结肠癌结肠切除术的所有患者。我们使用逻辑回归比较各省接受腹腔镜结肠切除术或开放性结肠切除术患者比例的时间变化。
在2004/05年至2014/15年期间接受择期结肠切除术的63504例患者中，19691例（31.0%）接受了腹腔镜结肠切除术。接受腹腔镜结肠切除术的患者年比例从2004/05年的9.2%增至2014/15年的51.5%（年均增长百分比为4.2%）。各省接受腹腔镜结肠切除术的患者总体比例存在显著差异（<0.001），范围从纽芬兰和拉布拉多的7.6%到安大略的36.9%。到2014/15年，在3个省份，大多数结肠切除术采用腹腔镜进行；不列颠哥伦比亚省（60.2%）、安大略省（59.4%）和艾伯塔省（53.1%）。除了年份和省份外，城市居住、年龄较小、女性、较少的内科合并症、高手术量、高医院手术量和右侧肿瘤与腹腔镜结肠切除术可能性增加显著相关。
尽管2004/05年至2014/15年期间加拿大腹腔镜结肠切除术的使用迅速增加，但各省之间仍存在很大差异。需要进一步的知识转化策略，以确保所有加拿大人都能平等地接受腹腔镜结肠切除术。
