Comparison of outcome and cost among open, laparoscopic, and robotic surgical treatments for rectal cancer: A propensity score matched analysis of nationwide inpatient sample data

• Published in: Journal of surgical oncology Vol. 117; no. 3; pp. 497 - 505
• Main Authors: Chen, Szu‐Ta, Wu, Meng‐Che, Hsu, Tzu‐Chun, Yen, Debra W., Chang, Chia‐Na, Hsu, Wan‐Ting, Wang, Chia‐Chun, Lee, Matthew, Liu, Shing‐Hwa, Lee, Chien‐Chang
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2018
• Subjects: Aged; Cancer surgery; Cohort Studies; Colorectal cancer; comparative effectiveness research; cost; Cost-Benefit Analysis; Female; Humans; Inpatients - statistics & numerical data; laparoscopic surgery; Laparoscopy; Laparoscopy - economics; Laparoscopy - methods; Laparoscopy - statistics & numerical data; Male; Middle Aged; Mortality; open surgery; Propensity Score; rectal cancer; Rectal Neoplasms - economics; Rectal Neoplasms - epidemiology; Rectal Neoplasms - surgery; Retrospective Studies; Robotic surgery; Robotic Surgical Procedures - economics; Robotic Surgical Procedures - methods; Robotic Surgical Procedures - statistics & numerical data; Treatment Outcome; United States - epidemiology; comparative effectiveness research; open surgery; cost; laparoscopic surgery; rectal cancer; robotic surgery
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.24867

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.