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Erschienen in:

08.08.2017 | Original Article

Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs

verfasst von: Benedetto Ielpo, H. Duran, E. Diaz, I. Fabra, R. Caruso, L. Malavé, V. Ferri, J. Nuñez, A. Ruiz-Ocaña, E. Jorge, S. Lazzaro, D. Kalivaci, Y. Quijano, E. Vicente

Erschienen in: International Journal of Colorectal Disease | Ausgabe 10/2017

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Abstract

Purpose

The costs involved in performing robotic surgery present a critical issue which has not been well addressed yet. The aims of this study are to compare the clinical outcomes and cost differences of robotic versus laparoscopic surgery in the treatment of rectal cancer and to conduct a literature review of the cost analysis.

Methods

This is an observational, comparative study whereby data were abstracted from a retrospective database of patients who underwent laparoscopic and robotic rectal resection from October 2010 to March 2017, at Sanchinarro University Hospital, Madrid. An independent company performed the financial analysis, and fixed costs were excluded.

Results

A total of 86 robotic and 112 laparoscopic rectal resections were included. The mean operative time was significantly lower in the laparoscopic approach (336 versus 283 min; p = 0.001). The main pre-operative data, overall morbidity, hospital stay and oncological outcomes were similar in both groups, except for the readmission rate (robotic: 5.8%, laparoscopic: 11.6%; p = 0.001). The mean operative costs were higher for robotic surgery (4285.16 versus 3506.11€; p = 0.04); however, the mean overall costs were similar (7279.31€ for robotic and 6879.8€ for the laparoscopic approach; p = 0.44). We found four studies reporting costs, three comparing robotic versus laparoscopy costs, with all of them reporting a higher overall cost for the robotic rectal resection.

Conclusion

Robotic rectal resection has similar clinical outcomes to that of the conventional laparoscopic approach. Despite the higher operative costs of robotic rectal resection, overall mean costs were similar in our series.
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Literatur
1.
Zurück zum Zitat Ielpo B, Vicente E, Quijano Y et al (2014) An organizational model to improve the robotic system among general surgeons. G Chir 35:52–55PubMedPubMedCentral Ielpo B, Vicente E, Quijano Y et al (2014) An organizational model to improve the robotic system among general surgeons. G Chir 35:52–55PubMedPubMedCentral
3.
Zurück zum Zitat Morelli L, Guadagni S, Lorenzoni V et al (2016) Robot-assisted versus laparoscopic rectal resection for cancer in a single surgeon’s experience: a cost analysis covering the initial 50 robotic cases with the da Vinci Si. Int J Color Dis 31:1639–1648CrossRef Morelli L, Guadagni S, Lorenzoni V et al (2016) Robot-assisted versus laparoscopic rectal resection for cancer in a single surgeon’s experience: a cost analysis covering the initial 50 robotic cases with the da Vinci Si. Int J Color Dis 31:1639–1648CrossRef
4.
Zurück zum Zitat Cubillo A, Hernando-Requejo O, Garcia-Garcia E et al (2014) A prospective pilot study of target-guided personalized chemotherapy with intensity-modulated radiotherapy in patients with early rectal cancer. Am J Clin Oncol 37(2):117–121CrossRefPubMed Cubillo A, Hernando-Requejo O, Garcia-Garcia E et al (2014) A prospective pilot study of target-guided personalized chemotherapy with intensity-modulated radiotherapy in patients with early rectal cancer. Am J Clin Oncol 37(2):117–121CrossRefPubMed
5.
Zurück zum Zitat Edge SB, Compton CC (2010) In: Edge Stephen B et al (eds) AJCC cancer staging manual, 7th edn. Springer, New York Edge SB, Compton CC (2010) In: Edge Stephen B et al (eds) AJCC cancer staging manual, 7th edn. Springer, New York
6.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Bertani E, Chiappa A, Biffi R et al (2011) Assessing appropriateness and quality-of-life short-term outcomes employing different treatment approaches. Int J Color Dis 26:1317–1327CrossRef Bertani E, Chiappa A, Biffi R et al (2011) Assessing appropriateness and quality-of-life short-term outcomes employing different treatment approaches. Int J Color Dis 26:1317–1327CrossRef
8.
Zurück zum Zitat Baek SJ, Kim SH, Cho JS et al (2012) Robotic versus conventional laparoscopic surgery for rectal cancer: a cost analysis from a single institute in Korea. World J Surg 36(11):2722–2729CrossRefPubMed Baek SJ, Kim SH, Cho JS et al (2012) Robotic versus conventional laparoscopic surgery for rectal cancer: a cost analysis from a single institute in Korea. World J Surg 36(11):2722–2729CrossRefPubMed
9.
Zurück zum Zitat Keller DS, Senagore AJ, Lawrence JK et al (2014) Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection. Surg Endosc 28:212–221CrossRefPubMed Keller DS, Senagore AJ, Lawrence JK et al (2014) Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection. Surg Endosc 28:212–221CrossRefPubMed
10.
Zurück zum Zitat Zhang X, Wei Z, Bie M et al (2016) Robot-assisted versus laparoscopic-assisted surgery for colorectal cancer: a meta-analysis. Surg Endosc 30:5601–5614CrossRefPubMed Zhang X, Wei Z, Bie M et al (2016) Robot-assisted versus laparoscopic-assisted surgery for colorectal cancer: a meta-analysis. Surg Endosc 30:5601–5614CrossRefPubMed
11.
Zurück zum Zitat Ielpo B, Caruso R, Quijano Y et al (2014) Robotic versus laparoscopic rectal resection: is there any real difference? A comparative single center study. Int J Med Robot 10:300–305CrossRefPubMed Ielpo B, Caruso R, Quijano Y et al (2014) Robotic versus laparoscopic rectal resection: is there any real difference? A comparative single center study. Int J Med Robot 10:300–305CrossRefPubMed
12.
Zurück zum Zitat Barnajian M, Pettet D, Kazi E et al (2014) Quality of total mesorectal excision and depth of circumferential resection margin in rectal cancer: a matched comparison of the first 20 robotic cases. Color Dis 16:603–609CrossRef Barnajian M, Pettet D, Kazi E et al (2014) Quality of total mesorectal excision and depth of circumferential resection margin in rectal cancer: a matched comparison of the first 20 robotic cases. Color Dis 16:603–609CrossRef
13.
Zurück zum Zitat Ghezzi TL, Luca F, Valvo M et al (2014) Robotic versus open total mesorectal excision for rectal cancer: comparative study of short and long-term outcomes. Eur J Surg Oncol 40:1072–1079CrossRefPubMed Ghezzi TL, Luca F, Valvo M et al (2014) Robotic versus open total mesorectal excision for rectal cancer: comparative study of short and long-term outcomes. Eur J Surg Oncol 40:1072–1079CrossRefPubMed
14.
Zurück zum Zitat Koh FH, Tan KK, Lieske B, Tsang ML, Tsang CB, Koh DC (2014) Endowrist versus wrist: a case-controlled study comparing robotic versus hand-assisted laparoscopic surgery for rectal cancer. Surg Laparosc Endosc Percutan Tech 24:452–456CrossRefPubMed Koh FH, Tan KK, Lieske B, Tsang ML, Tsang CB, Koh DC (2014) Endowrist versus wrist: a case-controlled study comparing robotic versus hand-assisted laparoscopic surgery for rectal cancer. Surg Laparosc Endosc Percutan Tech 24:452–456CrossRefPubMed
15.
Zurück zum Zitat Erguner I, Aytac E, Boler DE et al (2013) What have we gained by performing robotic rectal resection? Evaluation of 64 consecutive patients who underwent laparoscopic or robotic low anterior resection for rectal adenocarcinoma. Surg Laparosc Endosc Percutan Technol 23:316–319CrossRef Erguner I, Aytac E, Boler DE et al (2013) What have we gained by performing robotic rectal resection? Evaluation of 64 consecutive patients who underwent laparoscopic or robotic low anterior resection for rectal adenocarcinoma. Surg Laparosc Endosc Percutan Technol 23:316–319CrossRef
16.
Zurück zum Zitat Mak TW, Lee JF, Futaba K et al (2014) Robotic surgery for rectal cancer: a systematic review of current practice. World J Gastrointest Oncol 6:184–193PubMedPubMedCentral Mak TW, Lee JF, Futaba K et al (2014) Robotic surgery for rectal cancer: a systematic review of current practice. World J Gastrointest Oncol 6:184–193PubMedPubMedCentral
17.
Zurück zum Zitat Park EJ, Cho MS, Baek SJ et al (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg 261:129–137CrossRefPubMed Park EJ, Cho MS, Baek SJ et al (2015) Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg 261:129–137CrossRefPubMed
18.
Zurück zum Zitat Saklani AP, Lim DR, Hur H et al (2013) Robotic versus laparoscopic surgery for mid-low rectal cancer after neoadjuvant chemoradiation therapy: comparison of oncologic outcomes. Int J Color Dis 28:1689–1698CrossRef Saklani AP, Lim DR, Hur H et al (2013) Robotic versus laparoscopic surgery for mid-low rectal cancer after neoadjuvant chemoradiation therapy: comparison of oncologic outcomes. Int J Color Dis 28:1689–1698CrossRef
19.
Zurück zum Zitat Gomez M, Alonso J, Fernandez C et al (2016) Short- and mid-term outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Our experience after 198 consecutive cases. Eur J Surg Oncol 42:848–854CrossRef Gomez M, Alonso J, Fernandez C et al (2016) Short- and mid-term outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Our experience after 198 consecutive cases. Eur J Surg Oncol 42:848–854CrossRef
20.
Zurück zum Zitat Patriti A, Ceccarelli G, Bartoli A et al (2009) Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS 13:176–183PubMedPubMedCentral Patriti A, Ceccarelli G, Bartoli A et al (2009) Short- and medium-term outcome of robot-assisted and traditional laparoscopic rectal resection. JSLS 13:176–183PubMedPubMedCentral
Metadaten
Titel
Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs
verfasst von
Benedetto Ielpo
H. Duran
E. Diaz
I. Fabra
R. Caruso
L. Malavé
V. Ferri
J. Nuñez
A. Ruiz-Ocaña
E. Jorge
S. Lazzaro
D. Kalivaci
Y. Quijano
E. Vicente
Publikationsdatum
08.08.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 10/2017
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-017-2876-7

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