Knitter Sebastian, Maurer Max M, Winter Axel, Dobrindt Eva M, Seika Philippa, Ritschl Paul V, Raakow Jonas, Pratschke Johann, Denecke Christian
Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Cancers (Basel). 2023 Dec 25;16(1):112. doi: 10.3390/cancers16010112.
In recent decades, robotic-assisted minimally invasive esophagectomy (RAMIE) has been increasingly adopted for patients with esophageal cancer (EC) or cancer of the gastroesophageal junction (GEJ). However, concerns regarding its costs compared to conventional minimally invasive esophagectomy (MIE) have emerged. This study examined outcomes and costs of RAMIE versus total MIE in 128 patients who underwent Ivor Lewis esophagectomy for EC/GEJ at our department between 2017 and 2021. Surgical costs were higher for RAMIE (EUR 12,370 vs. EUR 10,059, < 0.001). Yet, median daily (EUR 2023 vs. EUR 1818, = 0.246) and total costs (EUR 30,510 vs. EUR 29,180, = 0.460) were comparable. RAMIE showed a lower incidence of postoperative pneumonia (8% vs. 25%, = 0.029) and a trend towards shorter hospital stays (15 vs. 17 days, = 0.205), which may have equalized total costs. Factors independently associated with higher costs included readmission to the intensive care unit (hazard ratio [HR] = 7.0), length of stay (HR = 13.5), anastomotic leak (HR = 17.0), and postoperative pneumonia (HR = 5.4). In conclusion, RAMIE does not impose an additional financial burden. This suggests that RAMIE may be considered as a valid alternative approach for esophagectomy. Attention to typical cost factors can enhance postoperative care across surgical methods.
近几十年来，机器人辅助微创食管切除术（RAMIE）越来越多地应用于食管癌（EC）或胃食管交界癌（GEJ）患者。然而，与传统微创食管切除术（MIE）相比，其成本问题引发了关注。本研究调查了2017年至2021年间在我院接受Ivor Lewis食管切除术治疗EC/GEJ的128例患者中，RAMIE与全MIE的疗效和成本。RAMIE的手术成本更高（12370欧元对10059欧元，<0.001）。然而，每日中位数成本（2023欧元对1818欧元，=0.246）和总成本（30510欧元对29180欧元，=0.460）具有可比性。RAMIE术后肺炎的发生率较低（8%对25%，=0.029），且住院时间有缩短趋势（15天对17天，=0.205），这可能使总成本趋于平衡。与较高成本独立相关的因素包括入住重症监护病房（风险比[HR]=7.0）、住院时间（HR=13.5）、吻合口漏（HR=17.0）和术后肺炎（HR=5.4）。总之，RAMIE不会带来额外的经济负担。这表明RAMIE可被视为食管切除术的一种有效替代方法。关注典型的成本因素可改善所有手术方式的术后护理。
