Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, Korea.
World J Surg. 2012 Nov;36(11):2722-9. doi: 10.1007/s00268-012-1728-4.
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.
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.
From July 2007 and August 2010, 154 robot-assisted 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).
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.
自引入以来，机器人手术已在微创外科的多个领域得到积极应用，其在结直肠外科领域的应用也在增加。在迄今为止的研究中，可行性和安全性一直是主要关注点，但所涉及的经济学问题也很重要。我们比较了机器人手术与腹腔镜手术治疗直肠癌的经济学情况。
我们分析了韩国大学安岩医院 2007 年 7 月至 2010 年 8 月期间接受机器人和腹腔镜直肠癌切除术的患者的临床特征、总住院费用、支付额、手术室费用和医院利润。
从 2007 年 7 月至 2010 年 8 月，进行了 154 例机器人辅助和 150 例腹腔镜直肠手术。两组患者的人口统计学特征相似，但肿瘤位置（距肛缘 6.7 与 8.7cm；p = 0.043）、术前放化疗（22.7%与 8%；p = 0.001）和手术时间（285.2 与 219.7min；p = 0.018）不同。两组术后过程和并发症也相似。机器人组的总住院费用（14647 美元与 9978 美元；p = 0.001）和患者支付额（11540 美元与 3956 美元；p<0.001）显著较高。机器人组的医院利润明显低于腹腔镜组（689 美元与 1671 美元；p<0.001）。
机器人辅助手术治疗直肠癌比腹腔镜手术更昂贵。考虑到机器人手术更容易应用于低位癌症，未来的研究应根据肿瘤学结果和功能结果来评估机器人直肠癌手术的成本效益。
