Racial and Ethnic Disparities in the Utilization of Partial Nephrectomy and Robotic Surgery for Renal Cell Carcinoma

Abstract

Objective: To evaluate racial and ethnic disparities in the utilization of robotic-assisted surgery and partial nephrectomy (PN) for renal cell carcinoma (RCC) across cT1a, cT1b, and cT2 stages and to identify socioeconomic and clinical factors contributing to these disparities. Methods: We queried the National Cancer Database for patients with cT1a–cT2 RCC undergoing upfront surgery from 2010 to 2019. Associations between race/ethnicity and the utilization of robotic-assisted surgery and PN were adjusted for demographic, socioeconomic, and clinical variables. Temporal trends were also evaluated. Results: Among 122,920 patients, rates of robotic-assisted surgery were higher among non-Hispanic White patients (NHW) across all tumor stages. Compared with NHW, both non-Hispanic Black (NHB) race and Hispanic ethnicity were independently associated with lower rates of robotic-assisted nephrectomy for cT1a and cT1b tumors, whereas odds for cT2 tumors were significant only among NHB patients. Both NHB and Hispanic patients had significantly lower odds of receiving PN for cT1a tumors (NHB: OR 0.71, 95% CI 0.66-0.75, P < .001; Hispanic: OR 0.80, 95% CI 0.74-0.86, P < .001 for both). Unlike Hispanic patients, however, NHB had higher odds of undergoing PN for cT1b (OR 1.18, 95% CI 1.09-1.28, P < .001) and cT2 tumors (OR 1.44, 95% CI 1.24-1.68, P < .001). Conclusions: Significant racial and ethnic disparities in the utilization of robotic surgical techniques for RCC occur not only for cT1a renal masses but also extend to more complex tumors. Targeted interventions are needed to expand equitable access to advanced RCC treatments across diverse populations.