The surgical approach mediated one-third of the complication risk experienced by rural patients
By Lori Solomon HealthDay Reporter
MONDAY, Sept. 15, 2025 (HealthDay News) — Rural residents with colon cancer are significantly less likely to undergo minimally invasive surgery (MIS) and significantly more likely to experience worse outcomes compared with urban residents, according to a study published online Sept. 10 in the Journal of the American College of Surgeons.
Sara Myers, M.D., from Boston University, and colleagues used the SEER-Medicare database to identify 33,183 individuals with colon cancer who underwent surgical resection. Rates of postoperative complications and reoperations were compared between rural and urban residents and an open versus MIS approach at 30, 60, and 90 days.
The researchers found that rural patients (18 percent) had lower Charlson comorbidity indices and presented less emergently; however, rural patients underwent more postdischarge reoperations and had higher odds of both surgical site infection (SSI; odds ratio [OR], 1.31) and anastomotic leak (AL; OR, 1.19). Rural patients were less likely to undergo MIS (OR, 0.67), which was associated with lower odds of SSI (OR, 0.58) and AL (OR, 0.57). For complications, surgical approach mediated 29 percent of the overall risk, including 18 percent for SSI risk and 28 percent for AL risk among rural patients. Across time points, survival was lower among rural patients.
“Expanding rural MIS colectomy practices may be one way to achieve more geographically equitable outcomes,” the authors write.
One author disclosed financial ties to SafeHeal, Medtronic, and Olympus.
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