Does race influence the attainment of the principles of oncologic surgical resection in colon adenocarcinoma? A retrospective cohort analysis from the national cancer database

Introduction: The standard operation for colon cancer resection should follow certain principles to ensure appropriate oncologic resection, such as retrieving 12 or more nodes with the specimen and adequate surgical margins. Although these principles are well documented, there is little evidence regarding the association of race and the attainment of an adequate oncologic resection. Methods: The authors performed a retrospective cohort study of all cases of resectable colon adenocarcinoma who underwent surgical resection in the National Cancer Database between 2004 and 2018. The postoperative lymph node count and margins were grouped as 'principles of oncologic surgical resection'. A multivariate logistic regression analysis was performed to assess race and other demographic variables as independent factors influencing the attainment of the principles of oncologic resection. Results: A total of 456 746 cases were included. From this cohort, 377 344 (82.6%) achieved an adequate oncologic resection and 79 402 (17.4%) did not. On logistic regression, African American and Native American patients were less likely to attain an adequate oncologic resection. Similarly, patients with an elevated Charlson-Deyo score (2 or above), stage I cancer, and patients who underwent extended resection were less likely to achieve adequate oncologic resection. Resections performed in metropolitan areas, patients with private insurance, high-income quartiles, and patients diagnosed in more recent years were more likely to achieve adequate oncologic resection. Conclusions: There are significant racial disparities regarding the attainment of the principles of oncologic resection in colon cancer, which could be explained by unconscious biases, social discrepancies, and inadequate healthcare access. Early introduction and conscientization of unconscious biases are required in surgical training.