Estimated effect of correcting inequalities in minimally invasive surgical resection in patients with colon cancer in England: a population-based study
Menées à partir de données anglaises portant sur des patients atteints d'un cancer du côlon de stade I-III, ces deux études analysent l'intérêt d'une chirurgie mini-invasive du point de vue de la mortalité et des inégalités de prise en charge
Background: Minimally invasive surgical resection offers advantages over open surgical resection in elective management of colon cancer. However, patients who are older, have comorbidities, or live in socioeconomically deprived areas are less likely to receive minimally invasive surgical resection. We aimed to estimate the potential effect on outcomes of correcting inequalities in minimally invasive surgical resection for colon cancer.
Methods: In this population-based study, we studied adult patients (aged 15–99 years) diagnosed with stage I–III carcinoma of the colon between Jan 1 and Dec 31, 2022, and followed up to Dec 31, 2023, who underwent elective resection as recorded in linked cancer registration data in England. We excluded patients diagnosed through an emergency route, diagnosed with metastatic disease (stage IV), with missing stage, not resected, and who underwent colon cancer surgery in a private hospital or in a UK National Health Service (NHS) Trust that recorded ten or fewer colon cancer resections in 2022. Only Trusts doing both minimally invasive surgical and open surgical resections were included to ensure correct modelling of the effect of correcting inequalities in minimally invasive surgical resections within each Trust. We designed scenarios to correct inequalities in minimally invasive surgical resection in each UK NHS Trust, targeting four suboptimal uptake groups (patients who were aged 65 years and older, patients with frailty, patients with comorbidities, and patients with high levels of socioeconomic deprivation). We used a potential outcomes framework and contrasted observed and potential outcomes to estimate the effect of reducing inequalities in use of minimally invasive surgical resection on four primary outcomes: the lengths of index stay and total hospital stay, the probability of readmission within 30 days of resection, and 1-year mortality after resection.
Findings: All analyses included data for 10 603 elective colon resections done in 123 NHS Trusts. The median follow-up time was 1·47 years (IQR 1·22–1·74). The mean age at diagnosis was 70·3 years (SD 11·4). 5487 (51·7%) patients were male and 5116 (48·3%) were female. Minimally invasive surgical resection was attempted in 8909 (84·0%) and completed in 7951 (75·0%), among whom there were substantial inequalities in the proportion of minimally invasive surgical resections among the four suboptimal uptake groups defined by age at diagnosis of 65 years and older (5495 [73·8%] vs 2456 [77·8%] in those younger than 65 years), most deprived quintiles (quintiles 3–5: 4114 [73·9%] vs 3837 [76·2%] in the least deprived quintiles), comorbidity (2348 [70·8%] vs 5603 [76·9%] in those without comorbidities), and a moderate or high frailty score (695 [64·1%] vs 7256 [76·2%] in those with a low frailty score). Patients with minimally invasive surgical resection had 3-day to 4-day shorter lengths of hospital stay than patients with open surgical resection. Proportions of 30-day readmission and 1-year mortality were lower in patients with minimally invasive surgical resection than in patients with open surgical resection (13·1% vs 18·1% and 2·9% vs 7·9%, respectively). Correcting inequalities in minimally invasive surgical resection resulted in reductions in total hospital stay of 1567 days, 975 days, 912 days, and 682 days following the corrective scenarios on age, deprivation, comorbidity, and frailty, respectively, and reductions in 1-year mortality for the whole cohort.
Interpretation: Correcting inequalities in implementation of minimally invasive surgical resection has the potential to reduce inequalities in colon cancer outcomes.
The Lancet Oncology , article en libre accès, 2026