Robotic versus conventional laparoscopic surgery for rectal cancer: A cost analysis from a single institute in Korea

Background: Since its introduction, robotic surgery has been applied actively in several fields of minimally invasive surgery, and its use in the field of colorectal surgery is also increasing. In the studies to date, feasibility and safety have been the main focus, but the economics involved are important to examine. We compared the economics of robotic surgery with those of laparoscopic surgery for rectal cancer. Material and methods: We analyzed the clinical characteristics, total hospital charges, payments, operating room costs, and hospital profits for patients who underwent robotic and laparoscopic resection of rectal cancer at Korea University Anam Hospital between July 2007 and August 2010. Results: From July 2007 and August 2010, 154 robotassisted and 150 laparoscopic rectal surgeries were performed. The patient demographics were similar in the two groups with the exception of tumor location (6.7 vs 8.7 cm distal to the anal verge; p = 0.043), preoperative chemoradiotherapy (22.7 vs 8 %; p = 0.001), and operative time (285.2 vs 219.7 min; p = 0.018). Postoperative course and complications were also similar in the two groups. The total hospital charges in U.S. dollars ($14,647 vs $9,978; p = 0.001) and payments made by patients ($11,540 vs $3,956; p<0.001) were significantly higher in the robotic group. Hospital profit was significantly lower in the robotic group than in the laparoscopic group ($689 vs $1,671; p<0.001). Conclusions: Robot-assisted surgery is more expensive than laparoscopic surgery for rectal cancer. Considering that robotic surgery can be applied more easily for low-lying cancers, the cost-effectiveness of robotic rectal cancer surgery should be assessed based on oncologic outcomes and functional results from future studies.