Hamamoto Hiroki, Ota Masato, Shima Takafumi, Kuramoto Toru, Kitada Kazuya, Taniguchi Kohei, Asakuma Mitsuhiro, Oura Yasuhiro, Ito Yuri, Lee Sang-Woong
Department of General and Gastroenterological Surgery Osaka Medical and Pharmaceutical University Takatsuki Japan.
Department of General Surgery Chibune Hospital Osaka Japan.
Ann Gastroenterol Surg. 2024 Nov 15;9(1):4-11. doi: 10.1002/ags3.12884. eCollection 2025 Jan.
Many studies have revealed the benefits of robotic surgery for rectal cancer; however, real-world data are insufficient. This study aimed to compare the short-term outcomes and perioperative costs of laparoscopic and robotic surgery for rectal cancer using a real-world database.
The data of patients who underwent laparoscopic or robotic surgery for rectal cancer between January 2018 and January 2021 from a nationwide Japanese inpatient database provided by Medical Data Vision Co., Ltd. were analyzed. We performed propensity score matching (PSM) analysis to compare the in-hospital mortality, morbidity, readmission rate, reoperation rate, length of postoperative stay, and medical costs between the two groups.
We performed PSM analysis on 18 952 eligible patients. After PSM, 1396 patients in the laparoscopic group and 1396 in the robotic group were compared. The robotic group had a lower surgical site infection rate (2.9% vs. 1.5%, = 0.010), lower respiratory failure rate (1.3% vs. 0.6%, = 0.049), and higher operative medical costs (1 291 371 vs. 1 312 462 JPY, = 0.013). The total medical costs of the two groups were comparable (1 862 439 vs. 1 895 822 JPY, = 0.051).
PSM analysis revealed that robotic surgery was associated with better outcomes than laparoscopic surgery in terms of surgical site infection and respiratory failure rates. The operative medical costs of robotic surgery were significantly higher than those of laparoscopic surgery. However, there was no significant difference in the total medical costs between robotic and laparoscopic surgery for rectal cancer.
许多研究揭示了机器人手术治疗直肠癌的益处；然而，真实世界的数据并不充分。本研究旨在使用真实世界数据库比较腹腔镜手术和机器人手术治疗直肠癌的短期结局和围手术期费用。
分析了2018年1月至2021年1月间从Medical Data Vision有限公司提供的全国性日本住院患者数据库中接受腹腔镜或机器人直肠癌手术的患者数据。我们进行了倾向评分匹配（PSM）分析，以比较两组患者的院内死亡率、发病率、再入院率、再次手术率、术后住院时间和医疗费用。
我们对18952例符合条件的患者进行了PSM分析。PSM后，比较了腹腔镜组的1396例患者和机器人组的1396例患者。机器人组的手术部位感染率较低（2.9%对1.5%，P=0.010），呼吸衰竭率较低（1.3%对0.6%，P=0.049），手术医疗费用较高（1291371对1312462日元，P=0.013）。两组的总医疗费用相当（1862439对1895822日元，P=0.051）。
PSM分析显示，在手术部位感染和呼吸衰竭率方面，机器人手术比腹腔镜手术的结局更好。机器人手术的手术医疗费用显著高于腹腔镜手术。然而，机器人手术和腹腔镜手术治疗直肠癌的总医疗费用没有显著差异。
