Regional Variation in the Utilization of Laparoscopy for the Treatment of Rectal Cancer: The Importance of Fellowship Training Sites

Background Compared to open rectal surgery, laparoscopy is associated with lower perioperative morbidity but unclear oncologic outcomes. Unique technical challenges exist with laparoscopic rectal surgery and access based on geographical location is unknown. The purpose of this study was to determine whether proximity to colorectal fellowship training sites influences laparoscopy utilization for rectal cancer surgery. Methods Population based retrospective spatial analysis assessing regional rates of laparoscopy use in patients (≥ 18 years of age) undergoing rectal cancer surgery in Canada (excluding Quebec) from April 2008 to March 2014. Results Overall, 11,261 patients underwent rectal cancer surgery. Four Canadian colorectal fellowship training centers were identified. Rectal surgeries were performed laparoscopically 27% of the time, and this significantly increased from 18.1 to 40.3% between 2008 and 2014. Multivariate analysis adjusting for province, disease, hospital, patient, and surgeon factors demonstrated that patients living within 25 km of a colorectal fellowship training site had 2.5 times higher odds of laparoscopy use and those living within 26–100 km had 1.8 times higher odds of laparoscopy [95% confidence interval (CI) 2.14–2.71, p