VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut; Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut; Department of Surgery, Yale School of Medicine, New Haven, Connecticut; National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut; Department of Surgery, Maine Medical Center, Portland, Maine.
J Surg Res. 2024 Oct;302:40-46. doi: 10.1016/j.jss.2024.07.007. Epub 2024 Jul 30.
Asian American and Native Hawaiian-Pacific Islanders (AAPI) are the fastest growing racial-ethnic group, with 18.9 million people in 2019, and is predicted to rise to 46 million by 2060. Colorectal cancer (CRC) is the most common cancer in AAPI men and the third most common in women. Treatment techniques like laparoscopic colectomy (LC) emerged as the standard of care for CRC resections; however, new robotic technologies can be advantageous. Few studies have compared clinical outcomes across minimally invasive approaches for AAPI patients with CRC. This study compares utilization and clinical outcomes of LC versus robotic colectomies (RCs) in AAPI patients.
We queried the American College of Surgeons National Surgical Quality Improvement Program database for elective RC and LC in AAPI patients from 2012 to 2020. Outcomes included unplanned conversion to open, operative time, complications, 30-d mortality, and length of stay. Multivariable logistic regression analyses assessed the association between outcomes and the operative approach.
Between 2012 and 2020, 83,841 patients underwent elective LC or RC. Four thousand six hundred fifty-eight AAPI patients underwent 3817 (82%) LCs and 841 (18%) RCs. In 2012, all procedures were performed laparoscopically; by 2020, 27% were robotic. Mean operative time was shorter in LC (192 versus 249 min, P < 0.001). On multivariable logistic regression, there was no difference in infection (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.59-1.12), anastomotic leak (OR 0.97, 95% CI 0.59-1.61), or death (OR 0.9, 95% CI 0.31-2.61). Length of stay was shorter for RC (-0.44 d, 95% CI -0.71 to -0.18 d).
Overall, AAPI postoperative outcomes are similar between LC and RC. Future studies that evaluate costs and resource utilization can assist hospitals in determining whether implementing robotic-assisted technologies in their hospitals and communities will be appropriate.
亚裔美国人和夏威夷原住民-太平洋岛民（AAPI）是增长最快的种族群体，2019 年有 1890 万人，预计到 2060 年将增长到 4600 万。结直肠癌（CRC）是 AAPI 男性中最常见的癌症，也是女性中第三常见的癌症。腹腔镜结肠切除术（LC）等治疗技术已成为 CRC 切除的标准治疗方法；然而，新的机器人技术可能具有优势。很少有研究比较过 AAPI 结直肠癌患者接受微创方法治疗的临床结果。本研究比较了 AAPI 患者中 LC 与机器人结肠切除术（RC）的应用和临床结果。
我们从 2012 年至 2020 年，在美国外科医师学会国家手术质量改进计划数据库中查询了 AAPI 患者的择期 RC 和 LC。结果包括计划外转为开放、手术时间、并发症、30 天死亡率和住院时间。多变量逻辑回归分析评估了结局与手术方式之间的关联。
2012 年至 2020 年间，83841 例患者接受了 LC 或 RC 治疗。4658 例 AAPI 患者接受了 3817 例（82%）LC 和 841 例（18%）RC。2012 年所有手术均为腹腔镜手术，到 2020 年，27%为机器人手术。LC 的平均手术时间更短（192 分钟与 249 分钟，P<0.001）。多变量逻辑回归分析显示，感染（比值比[OR]0.8，95%置信区间[CI]0.59-1.12）、吻合口漏（OR 0.97，95%CI 0.59-1.61）或死亡（OR 0.9，95%CI 0.31-2.61）无差异。RC 的住院时间更短（-0.44 天，95%CI-0.71 至-0.18 天）。
总体而言，LC 和 RC 之间 AAPI 的术后结果相似。未来评估成本和资源利用的研究可以帮助医院确定在其医院和社区中实施机器人辅助技术是否合适。
