2. Evaluate whether racial-ethnic disparities in surgical outcomes of colon cancer, including positive surgical margins, inadequate lymphadenectomy, complications, and inpatient admissions exist in the equal access MHS.
3. Discuss the importance of access to quality surgical oncology care in minimizing racial-ethnic disparities in surgery and its outcomes for colon cancer.
Background: Racial-ethnic disparities in receipt of treatment and survival outcomes of colon cancer have been documented in the general U.S. population, with access to care identified as a contributor to the disparities. Less is known about disparities in quality aspects of colon cancer surgery, such as achievement of negative surgical margins, adequate lymphadenectomy, and complication rates. We aimed to study colon cancer surgery and postoperative outcomes in the Military Health System (MHS), which provides access to care regardless of patient demographic or socioeconomic characteristics, to better understand racial-ethnic disparities in surgical oncology care in an equal access setting. Material and Methods: We used the MilCanEpi database to identify patients aged 18 or older who were diagnosed with stage I-III colon adenocarcinoma between 2001 and 2014 and received colectomy as primary surgical treatment. The occurrence of positive surgical margins, inadequate lymphadenectomy (<12 nodes examined), 30-day complications (general: surgical site infection, hemorrhage, myocardial infarction, stroke, thrombosis; or gastrointestinal: bowel obstruction or intra-abdominal abscess), and 30-day inpatient admissions were captured. Multivariable logistic regression models estimated the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) in association with race-ethnicity for each outcome. Results: The study included 157 Asian, 257 non-Hispanic Black, 110 Hispanic, and 1115 non-Hispanic White patients. Overall, the frequency of positive margins (7.6%), inadequate lymphadenectomy (28.9%), 30-day complications (33.1%), or 30-day inpatient admissions (14.3%) did not differ significantly between racial-ethnic groups (all AORs and their 95% CIs included 1.00). In considering type of complication (general or gastrointestinal), Black patients had a significantly lower likelihood of general complications (AOR=0.61, 95% CI=0.37, 0.99) compared to non-Hispanic White patients, with no other statistically significant racial-ethnic differences in complication type. Conclusions: In the equal access MHS, there were no overall significant racial-ethnic differences in experience of adverse outcomes of colectomy for non-metastatic colon cancer. Our findings highlight the role of access to care in minimizing racial or ethnic disparities in colon cancer surgery and postoperative outcomes in the U.S.