Dehlaghi Jadid Kaveh, Gadan Soran, Wallin Göran, Nordenvall Caroline, Boman Sol Erika, Myrberg Ida Hed, Matthiessen Peter
Department of Surgery, School of Medicine and Health Sciences, Örebro University, Örebro, Sweden.
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Colorectal Dis. 2025 May;27(5):e70111. doi: 10.1111/codi.70111.
This study aimed to estimate the impact of socioeconomic status on the probability of receiving open (OPEN) or minimally invasive surgery (MIS) for curative abdominal rectal cancer resection.
All patients diagnosed with rectal cancer clinical Stage I-III during the period 2010-2021 who underwent curative abdominal resection surgery, MIS or OPEN, were included. Patients were identified in the Colorectal Cancer Database, a register-linkage based on the Swedish Colorectal Cancer Register and linked to several national Swedish health-related and demographic registers. Socioeconomic factors, sex, patient and tumour characteristics, number of previous surgical procedures and category of hospital were collected. Exposures were level of education (categorized as 6-9, 10-12, >12 years), household income (quartiles 1-4) and country of birth (Sweden, Nordic countries outside Sweden, Europe outside the Nordic countries, outside Europe), and outcome was MIS or OPEN. Multivariable logistic regression models were fitted for each exposure, adjusted for age, sex, cT and cN, level of tumour, and number of previous abdominal surgical procedures.
A total of 13 778 patients were included of whom 43.6% underwent MIS (n = 6007) and 56.4% OPEN (n = 7771). Highest level of education (OR for highest vs. lowest level of education 1.15; 95% CI 1.03-1.29) and highest household income quartile (OR for highest vs. lowest household income quartile 1.27; 95% CI 1.12-1.44) increased the likelihood of receiving MIS.
Despite the tax-financed healthcare system in Sweden, rectal cancer patients with the highest level of education and the highest household income had an increased probability of receiving MIS.
本研究旨在评估社会经济地位对根治性腹直肠癌切除采用开放手术（OPEN）或微创手术（MIS）概率的影响。
纳入2010年至2021年期间所有诊断为临床I - III期直肠癌且接受了根治性腹部切除术（MIS或OPEN）的患者。患者通过结直肠癌数据库识别，该数据库是基于瑞典结直肠癌登记处的登记链接，并与瑞典几个国家健康相关和人口登记处相链接。收集了社会经济因素、性别、患者和肿瘤特征、既往手术次数以及医院类别。暴露因素为教育水平（分为6 - 9年、10 - 12年、>12年）、家庭收入（四分位数1 - 4）和出生国家（瑞典、瑞典以外的北欧国家、北欧以外的欧洲国家、欧洲以外），结局为MIS或OPEN。针对每个暴露因素拟合多变量逻辑回归模型，并对年龄、性别、cT和cN、肿瘤分期以及既往腹部手术次数进行调整。
共纳入13778例患者，其中43.6%接受了MIS（n = 6007），56.4%接受了OPEN（n = 7771）。最高教育水平（最高与最低教育水平相比的OR为1.15；95%CI为1.03 - 1.29）和最高家庭收入四分位数（最高与最低家庭收入四分位数相比的OR为1.27；95%CI为1.12 - 1.44）增加了接受MIS的可能性。
尽管瑞典实行税收资助的医疗保健系统，但教育水平最高和家庭收入最高的直肠癌患者接受MIS的概率增加。
