Carla F Justiniano1, Adan Z Becerra2, Zhaomin Xu1, Christopher T Aquina1, Courtney I Boodry1, Maria J Schymura3, Francis P Boscoe3, Katia Noyes4, Larissa K Temple1, Fergal J Fleming1. 1. Department of Surgery, Surgical Health Outcomes & Research Enterprise, University of Rochester Medical Center, Rochester, New York. 2. Department of Surgery, Surgical Health Outcomes & Research Enterprise, University of Rochester Medical Center, Rochester, New York; Department of Public Health Sciences, Division of Epidemiology, University of Rochester Medical Center, Rochester, New York. Electronic address: abecerra@s-3.com. 3. New York State Cancer Registry, New York State Department of Health, Albany, New York. 4. Department of Epidemiology and Environmental Health, The State University of New York at Buffalo, Buffalo, New York.
Abstract
BACKGROUND: The role of robotic surgery in colorectal cancer remains contentious with most data arising from small, single-institution studies. METHODS: Stage I-III colorectal cancer resections from 2008 to 2014 were identified in New York State. Propensity score-adjusted negative binomial models were used to compare cost and utilization between robotic, laparoscopic, and open resections. RESULTS: A total of 12,218 patients were identified. For colectomy, the robotic-to-open conversion rate was 3%, and the laparoscopic-to-open conversion rate was 13%. For rectal resection, the robotic-to-open conversion rate was 7% and the laparoscopic-to-open conversion rate was 32%. In intention-to-treat analysis, there was no significant difference in cost across the surgical approaches, both in overall and stratified analyses. Both laparoscopic and robotic approaches were associated with decreased 90-d hospital utilization compared with open surgery in intention-to-treat analyses. CONCLUSIONS: Robotic and laparoscopic colorectal cancer resections were not associated with a hospital cost benefit after 90 d compared with open but were associated with decreased hospital utilization. Conversion to open resection was common, and efforts should be made to prevent them. Future research should continue to measure how robotic and laparoscopic approaches can add value to the health care system.
BACKGROUND: The role of robotic surgery in colorectal cancer remains contentious with most data arising from small, single-institution studies. METHODS: Stage I-III colorectal cancer resections from 2008 to 2014 were identified in New York State. Propensity score-adjusted negative binomial models were used to compare cost and utilization between robotic, laparoscopic, and open resections. RESULTS: A total of 12,218 patients were identified. For colectomy, the robotic-to-open conversion rate was 3%, and the laparoscopic-to-open conversion rate was 13%. For rectal resection, the robotic-to-open conversion rate was 7% and the laparoscopic-to-open conversion rate was 32%. In intention-to-treat analysis, there was no significant difference in cost across the surgical approaches, both in overall and stratified analyses. Both laparoscopic and robotic approaches were associated with decreased 90-d hospital utilization compared with open surgery in intention-to-treat analyses. CONCLUSIONS: Robotic and laparoscopic colorectal cancer resections were not associated with a hospital cost benefit after 90 d compared with open but were associated with decreased hospital utilization. Conversion to open resection was common, and efforts should be made to prevent them. Future research should continue to measure how robotic and laparoscopic approaches can add value to the health care system.
Authors: Sarah E Diaz; Yongjin F Lee; Amir L Bastawrous; I-Fan Shih; Shih-Hao Lee; Yanli Li; Robert K Cleary Journal: Surg Endosc Date: 2022-02-22 Impact factor: 3.453