OBJECTIVES : Clinical studies have shown that minimally invasive surgery (MIS) for colorectal cancer is associated with shorter recovery time and hospital length of stay relative to open surgery; however, only 40-50% of colorectal cancer patients receive MIS. This study sought to identify factors associated with receipt of MIS for elective colorectal cancer resection.

METHODS : Colorectal cancer patients diagnosed in 2009-2013 were selected from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Database. The study included elective colorectal resection patients age ≥66yr, enrolled in fee-for-service Medicare Part A & B for 1 year prior to surgery. Logistic regression was used to quantify the association between patient, tumor, hospital, and provider factors and receipt of MIS (laparoscopic or robotic surgery) vs. open resection for colorectal cancer.

RESULTS : The eligible study sample included 16,997 patients (median age=76yr; 53.3% female) who underwent elective resection for colorectal cancer; 52.3% received MIS. In multivariable analyses: patient factors associated with greater likelihood of MIS included younger patient age (p<0.0001), colon (vs. rectal) cancer site (p<0.0001), smaller tumor size (p<0.0001), non-metastatic cancer (p<0.0001), more recent diagnosis year (monotonic increase from 2009-2013; p<0.0001); institutional factors associated with greater likelihood of MIS included National Cancer Institute Cancer Center status or Commission on Cancer accreditation (p=0.001), larger hospital size by bed count (p<0.0001), and physician specialization in colorectal surgery (p<0.0001). In addition, significant variation in MIS utilization was observed across geographic regions (p<0.0001).

CONCLUSIONS : Selection of surgical approach in elective colorectal cancer resections performed in older adults was partially explained by measured patient, tumor, hospital, and provider factors. Independent of these factors, we observed a significant increase in MIS utilization from 2009 through 2013, and substantial geographic heterogeneity in MIS utilization. Better understanding of the factors associated with the selection of surgical approach may inform future comparative effectiveness studies and efforts to expand access to care.