Markin and colleagues¹ examined the role of surgery in an effort to explain why American Indians (AIs) have the poorest survival rates for cancer among all ethnic groups in the United States. Despite all the issues associated with a retrospective cohort study using an administrative database, the authors identified some important disparities. Compared with non-Hispanic white patients, AI patients were younger, had more comorbid conditions, and were more likely to have surgery in smaller, rural hospitals. Despite these inequities, short-term surgical outcomes were similar.

If we look closer, however, we see that the types of surgical resections were different, with fewer lung or colon resections in the AI cohort. Also, in-hospital mortality was higher in AI patients who underwent more technically demanding surgery for rectal and esophageal cancers. Because of the small numbers involved, these findings did not affect the overall findings but suggest that, for certain surgical procedures, surgical care systems in place in large cancer centers may allow for improved surgical outcomes.