Guerrero-Ortíz María Alejandra, Pellino Gianluca, Pascual Damieta Marta, Gimeno Marta, Alonso Sandra, Podda Mauro, Toledano Miguel, Núñez-Alfonsel Javier, Selvaggi Lucio, Acosta-Merida María Asunción, Bellido Juan, Ielpo Benedetto
Hepato Pancreato Biliary Unit. Hospital del Mar. Pompeu Fabra University, Barcelona, Spain.
Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona UAB, Barcelona, Spain. Electronic address: https://twitter.com/GianlucaPellino.
Surgery. 2025 Apr;180:109134. doi: 10.1016/j.surg.2024.109134. Epub 2025 Jan 28.
The costs related to robotic surgery are known to be greater than those associated with laparoscopy. However, the potential for better outcomes of the former could lead to a cost-effectiveness advantage. The aim of this study is therefore to highlight the difference in cost-effectiveness between robotic and laparoscopic rectal resection.
This is an observational, multicenter, national prospective study (ROBOCOSTES). From 2022, for 1 year, all consecutive patients undergoing minimally invasive rectal resection were included. Quality-adjusted life year and cost data were prospectively collected. The primary aim was to assess the cost-effectiveness of robotic rectal resection and laparoscopic rectal resection . Secondary aims included clinical outcomes and quality of life.
Overall, 182 patients underwent rectal resection (152 anterior and 30 abdominoperineal excisions) at 14 centers, of whom 95 received robotic rectal resection and 87 laparoscopic rectal resection. Robotic rectal resection was associated with lesser blood loss (58.55 ± 51.68 vs 131.68 ± 191.92, P < .001), lower pain score at day 1 (-1.04 visual analog scale, P < .001) and day 7 (-0.81, P < .001) after surgery, and with fewer hospital readmissions (2.1% vs 15%, P = .005) compared with laparoscopic rectal resection. The overall costs of robotic rectal resection (including hospitalization) were 919.66 euros greater compared with laparoscopic rectal resection, but quality-adjusted life years in the robotic rectal resection group were better than laparoscopic approaches to rectal resection both at 30-day (0.8914 vs 0.8139) and 90-day (0.9573 vs 0.8740) follow-up. At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was an 84.38% and 89.36% probability that robotic rectal resection was more cost-effective than laparoscopic rectal resection.
This study showed that robotic rectal resection, even if associated with greater direct costs in the short term, outperforms laparoscopic rectal resection in terms of quality-adjusted life years and should therefore be preferred where available.
已知机器人手术相关成本高于腹腔镜手术。然而，前者潜在的更好疗效可能带来成本效益优势。因此，本研究旨在突出机器人直肠切除术与腹腔镜直肠切除术在成本效益方面的差异。
这是一项观察性、多中心、全国性前瞻性研究（ROBOCOSTES）。从2022年起，连续1年纳入所有接受微创直肠切除术的患者。前瞻性收集质量调整生命年和成本数据。主要目的是评估机器人直肠切除术和腹腔镜直肠切除术的成本效益。次要目的包括临床结局和生活质量。
总体而言，14个中心的182例患者接受了直肠切除术（152例前切除术和30例腹会阴联合切除术），其中95例接受机器人直肠切除术，87例接受腹腔镜直肠切除术。与腹腔镜直肠切除术相比，机器人直肠切除术术中失血量更少（58.55±51.68对131.68±191.92，P<.001），术后第1天（视觉模拟评分-1.04，P<.001）和第7天（-0.81，P<.001）疼痛评分更低，再次入院率更低（2.1%对15%，P=.005）。机器人直肠切除术（包括住院）的总体成本比腹腔镜直肠切除术高919.66欧元，但在30天（0.8914对0.8139）和90天（0.9573对0.8740）随访时，机器人直肠切除术组的质量调整生命年优于腹腔镜直肠切除术。在支付意愿阈值为20000欧元和30000欧元时，机器人直肠切除术比腹腔镜直肠切除术更具成本效益的概率分别为84.38%和89.36%。
本研究表明，机器人直肠切除术即使在短期内与更高的直接成本相关，但在质量调整生命年方面优于腹腔镜直肠切除术，因此在可行的情况下应优先选择。
