Expanding the use of minimally invasive surgery in rural areas may help reduce rural-urban disparities

CHICAGO (September 10, 2025) — Surgical patients in rural areas who are undergoing colectomy for cancer could benefit greatly from the expanded use of minimally invasive surgery, according to new research findings published in the Journal of the American College of Surgeons.

Rural populations have higher rates of death from colon cancer than urban populations and may have more complications after colon cancer resection. To address this disparity, researchers from Boston Medical Center analyzed whether different surgical approaches may explain why patients in rural areas have different recovery results.

The researchers looked at 33,183 individuals age 66 or older from the SEER-Medicare database and found that a minimally invasive approach was associated with lower complication risks compared with open surgery and helped reduce a significant portion of the complication risk rural patients face.

Study Results

• Rural patients had higher rates of overall complications at 30, 60, and 90 days and more post-discharge reoperations.
• Rural patients showed worse survival at 30 days, 90 days, and one year postoperatively.
• Minimally invasive adoption was significantly lower in rural settings, despite its protective effect against surgical site infection and anastomotic leak.
• Surgical approach accounts for nearly a third of the rural-urban gap in postoperative complications.
• Expanding access to minimally invasive colectomy in rural hospitals may help achieve more equitable surgical outcomes.

Understanding factors, such as surgical approach, that impact rural-urban outcome disparities may help target interventions to create more equitable outcomes in rural areas. 

The study is published as an article in press on the JACS website. 

Citation: Myers S, Davis ES, Murillo A, et al. Surgical approach as a mediator of rural-urban disparities following colon cancer resection. Journal of the American College of Surgeons, 2025. DOI: 10.1097/XCS.0000000000001601

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About the American College of Surgeons
The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The ACS is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The ACS has approximately 90,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons.

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