Szu-Ta Chen1,2,3,4, Meng-Che Wu5,6, Tzu-Chun Hsu6, Debra W Yen7, Chia-Na Chang8, Wan-Ting Hsu4,6, Chia-Chun Wang9,10, Matthew Lee11, Shing-Hwa Liu3,12, Chien-Chang Lee6. 1. Division of Gastroenterology, Department of Pediatrics, National Taiwan University Hospital Yun-Lin Branch, Taipei, Taiwan. 2. Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan. 3. Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan. 4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 5. Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. 6. Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. 7. Department of Internal Medicine, School of Medicine, Washington University in St. Louis, Saint Louis, Missouri. 8. Department of Radiation Oncology, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan. 9. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan. 10. Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. 11. Medical Wisdom Inc., Houston, Texas. 12. Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
Abstract
BACKGROUND: Population-based studies evaluating outcomes of different approaches for rectal cancer are scarce. METHODS: We conducted a retrospective cohort study using the Nationwide Inpatient Sample database between 2008 and 2012. We compared the outcomes and costs among rectal cancer patients undergoing robotic, laparoscopic, or open surgeries using propensity scores for adjusted and matched analysis. RESULTS: We identified 194 957 rectal cancer patients. Over the 5-year period, the annual admission number decreased by 13.9%, the in-hospital mortality rate decreased by 32.2%, while the total hospitalization cost increased by 13.6%. Compared with laparoscopic surgery, robotic surgery had significantly lower length of stay (LOS) (OR 0.69, 95%CI 0.57-0.84), comparable wound complications (OR 1.08, 95%CI 0.70-1.65) and higher cost (OR 1.42, 95%CI 1.13-1.79), while open surgery had significantly longer LOS (OR 1.38, 95%CI 1.19-1.59), more wound complications (OR 1.49, 95%CI 1.08-1.79), and comparable cost (OR 0.92, 95%CI 0.79-1.07). There were no difference in in-hospital mortality among three approaches. CONCLUSIONS: Laparoscopic surgery was associated with better outcomes than open surgery. Robotic surgery was associated with higher cost, but no advantage over laparoscopic surgery in terms of mortality and complications. Studies on cost-effectiveness of robotic surgery may be warranted.
BACKGROUND: Population-based studies evaluating outcomes of different approaches for rectal cancer are scarce. METHODS: We conducted a retrospective cohort study using the Nationwide Inpatient Sample database between 2008 and 2012. We compared the outcomes and costs among rectal cancerpatients undergoing robotic, laparoscopic, or open surgeries using propensity scores for adjusted and matched analysis. RESULTS: We identified 194 957 rectal cancerpatients. Over the 5-year period, the annual admission number decreased by 13.9%, the in-hospital mortality rate decreased by 32.2%, while the total hospitalization cost increased by 13.6%. Compared with laparoscopic surgery, robotic surgery had significantly lower length of stay (LOS) (OR 0.69, 95%CI 0.57-0.84), comparable wound complications (OR 1.08, 95%CI 0.70-1.65) and higher cost (OR 1.42, 95%CI 1.13-1.79), while open surgery had significantly longer LOS (OR 1.38, 95%CI 1.19-1.59), more wound complications (OR 1.49, 95%CI 1.08-1.79), and comparable cost (OR 0.92, 95%CI 0.79-1.07). There were no difference in in-hospital mortality among three approaches. CONCLUSIONS: Laparoscopic surgery was associated with better outcomes than open surgery. Robotic surgery was associated with higher cost, but no advantage over laparoscopic surgery in terms of mortality and complications. Studies on cost-effectiveness of robotic surgery may be warranted.
Authors: Javier Mar; Ane Anton-Ladislao; Oliver Ibarrondo; Arantzazu Arrospide; Santiago Lázaro-Aramburu; Nerea Gonzalez; Marisa Bare; Antonio Escobar; Maximino Redondo; José M Quintana Journal: Surg Endosc Date: 2019-05-28 Impact factor: 4.584
Authors: L J X Giesen; J W T Dekker; M Verseveld; R M P H Crolla; G P van der Schelling; C Verhoef; P B Olthof Journal: Surg Endosc Date: 2022-08-30 Impact factor: 3.453