Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Division of Thoracic and Foregut Surgery, University of Rochester Medical Center, Rochester, New York.
J Surg Res. 2024 Oct;302:24-32. doi: 10.1016/j.jss.2024.07.008. Epub 2024 Jul 28.
Robotic surgery has become an increasingly utilized approach for resectable lung cancer. However, availability may be limited for certain patient populations, underscoring inequity in access to innovative surgical techniques. We hypothesize that there is an association between social determinants of health and robotic surgery utilization for resectable non-small cell lung cancer (NSCLC).
We queried the National Cancer Database (2010-2019) for patients with clinical stage I-III NSCLC who underwent resection, stratifying the cohort based on surgical technique. Multivariable logistic regression analysis was performed to identify associations between sociodemographic and clinicopathologic factors and the robotic approach.
Among the 226,455 clinical stage I-III NSCLC patients identified, 34,059 (15%) received robotic resections, 78,039 (34.5%) underwent thoracoscopic resections, and 114,357 (50.5%) had open resections. Robotic surgery utilization increased from 3.1% in 2010 to 34% in 2019 (P < 0.001). Despite this, after adjusting by clinical stage, extent of resection, site of tumor, and receipt of neoadjuvant therapy, multivariable analysis revealed various sociodemographic and treatment facility factors that were associated with underutilization of this approach: lack of insurance (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.73-0.93), lower income brackets (aOR 0.93, 95% CI 0.91-0.96), provincial settings (urban aOR 0.79, 95% CI 0.76-0.82; rural aOR 0.57, 95% CI 0.51-0.64), and treatment at community centers (comprehensive community cancer programs aOR 0.73, 95% CI 0.70-0.75; community cancer programs aOR 0.51, 95% CI 0.47-0.55).
This study suggests that disparities in determinants of health influence accessibility to robotic surgery for resectable NSCLC. Identification of these gaps is crucial to target vulnerable sectors of the population in promoting equality and uniformity in surgical treatment.
机器人手术已成为治疗可切除肺癌的一种越来越常用的方法。然而，对于某些患者群体，其可用性可能有限，这突显了在获得创新手术技术方面存在的不平等。我们假设，健康的社会决定因素与可切除非小细胞肺癌 (NSCLC) 的机器人手术应用之间存在关联。
我们从国家癌症数据库（2010-2019 年）中查询了接受切除术的临床 I-III 期 NSCLC 患者，根据手术技术对队列进行分层。使用多变量逻辑回归分析来确定社会人口统计学和临床病理学因素与机器人方法之间的关联。
在确定的 226455 例临床 I-III 期 NSCLC 患者中，有 34059 例（15%）接受了机器人切除术，78039 例（34.5%）接受了胸腔镜切除术，114357 例（50.5%）接受了开放性切除术。机器人手术的使用率从 2010 年的 3.1%增加到 2019 年的 34%（P<0.001）。尽管如此，在通过临床分期、切除范围、肿瘤部位和接受新辅助治疗进行调整后，多变量分析显示，各种社会人口统计学和治疗设施因素与这种方法的应用不足有关：缺乏保险（调整后的优势比 [aOR] 0.83，95%置信区间 [CI] 0.73-0.93）、较低的收入阶层（aOR 0.93，95%CI 0.91-0.96）、省级环境（城市 aOR 0.79，95%CI 0.76-0.82；农村 aOR 0.57，95%CI 0.51-0.64）和社区中心的治疗（综合社区癌症计划 aOR 0.73，95%CI 0.70-0.75；社区癌症计划 aOR 0.51，95%CI 0.47-0.55）。
本研究表明，健康决定因素方面的差异会影响可切除 NSCLC 患者获得机器人手术的机会。确定这些差距对于针对弱势群体，促进手术治疗的平等和一致性至关重要。
