Racial Disparities in the Use of Minimally Invasive Surgery for Gastrointestinal Cancer

Introduction: Racial disparities in minimally invasive surgery (MIS) utilization across gastrointestinal (GI) cancers are not well characterized. We evaluated racial/ethnic disparities in the use of MIS approaches and associated outcomes.

Methods: We analyzed a cohort of patients with GI cancer in the National Cancer Database (2010-2020). Multinomial logistic regression was used to evaluate associations between race/ethnicity and approach. Logistic regression was used to assess 30-day readmission and 90-day mortality. Cox regression was used to analyze overall survival. Models were adjusted for demographics, clinical characteristics, cancer factors, and facility features.

Results: Of the 839 398 patients included, 76.9% were White, 11.6% Black, 6.6% Hispanic/Latino, 4.0% Asian, and 0.3% Indigenous. Compared with patients of White race, the odds of robotic surgery were lower for Black (OR 0.89, 95% CI 0.86-0.93) and Indigenous patients (OR 0.72, 95% CI 0.59-0.89), but higher for Hispanic/Latino (OR 1.12, 95% CI 1.08-1.17) and Asian patients (OR 1.27, 95% CI 1.21-1.34). Indigenous patients had higher odds of readmission (OR 1.41, 95% CI 1.23-1.62), 90-day mortality (OR 1.31, 95% CI 1.11-1.54), and worse overall survival (HR 1.11, 95% CI 1.05-1.18).

Conclusion: Indigenous and Black patients have lower utilization of minimally invasive approaches and worse outcomes in GI cancer care.