机器人手术在结直肠癌手术中的使用逐渐增加，但平台的附加费用可能会在传播过程中引入挑战。我们假设采用机器人手术会在结直肠癌患者中引入新的差异，特别是在患者保险组之间。这个横断面研究分析了2010年至2019年国家癌症数据中临床I-III期结直肠癌手术病例。主要结果是手术方法（机器人、腹腔镜或组合的“微创手术”）；预测因素是患者的主要付款人；潜在混杂因素包括社会人口统计学、肿瘤特征和设施。生成层次多变量模型，并进行敏感性分析。在结直肠癌手术中，MIS方法从2010年的39%增加到了2019年的73%，主要推动因素是机器人手术从2%增加到了24%。对于腹腔镜手术，私人保险和州医疗补助之间的差距从2010年的11%缩小到2019年的4%，而机器人手术的这种差距从2010年的1%增加到2019年的5%。在调整后的分析中，Medicaid（比值比[OR]为0.86 [CI 0.79-0.95]）和没有保险（OR为0.67 [CI 0.56-0.79]）的患者，在2019年接受机器人手术的几率低于私人保险的患者。这种差异在五项敏感性分析中保持一致。随着结直肠癌手术领域从腹腔镜手术向机器人手术的转变，不同保险患者之间的新不平等正在出现。需要采取积极措施确保所有患者受益于微创手术。©2023年。外科肿瘤学会。

The use of the robotic approach is increasing for colorectal cancer operations, but the added cost of the platform has the potential to introduce challenges in its dissemination. We hypothesized that adoption of the robot is introducing new disparities in access to minimally invasive surgery (MIS) for colorectal cancer, especially across patient insurance groups.This cross-sectional study analyzed surgical cases of stage I-III colorectal cancer from the National Cancer Database (NCDB) between 2010 and 2019. The primary outcome was surgical approach (robotic, laparoscopic, or the composite "MIS"). The predictor was a patient's primary payor. Potential confounders included sociodemographics, tumor characteristics, and the facility. Hierarchical multivariable models were generated, and sensitivity analyses were performed.For colorectal cancer operations, the MIS approach increased from 39% in 2010 to 73% in 2019, driven predominantly by an increase in the robotic approach from 2 to 24%. For laparoscopy, the size of the disparity between patients with Private insurance and Medicaid shrank from 11% (2010) to 4% (2019), whereas this disparity increased for the robotic approach from 1% (2010) to 5% (2019). On adjusted analysis, patients with Medicaid (odds ratio [OR] 0.86 [CI 0.79-0.95]) and the Uninsured (OR 0.67 [CI 0.56-0.79]) had lower odds of receiving a robotic operation than those with Private insurance in 2019. This disparity remained consistent across five sensitivity analyses.As the field of colorectal cancer surgery shifts away from laparoscopy and toward robotics, new inequities across patient insurance are emerging. Proactive efforts are needed to ensure all patients benefit from a minimally invasive approach.© 2023. Society of Surgical Oncology.