Ma Lei, Liu Ruihan, Hu Chenhao, Zhang Lei, Qu Penghong, She Junjun
Department of General Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China.
Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Surg Endosc. 2025 Jun;39(6):3959-3969. doi: 10.1007/s00464-025-11775-5. Epub 2025 May 13.
Robotic and endoscopic cooperative surgery (RECS) is an emerging and promising therapeutic approach for treating gastric submucosal tumors (GSMTs). However, the efficacy of RECS has not been well established, and its high medical costs significantly limit its application.
This nested cohort study examined patients with GSMTs managed with different surgical techniques. A total of 314 consecutive patients were enrolled in this study, including 61 patients treated with RECS, 196 patients treated laparoscopically, and 57 patients treated with open surgery. To mitigate confounding bias, 1:1:1 propensity score matching (PSM) was utilized. The perioperative outcomes, postoperative gastrointestinal symptoms, long-term outcomes, and cost-effectiveness among the three groups were compared.
After PSM, 51 patients were included in each group. Compared with the laparoscopic and open surgical groups, the RECS group presented significantly lower intraoperative bleeding volumes, times to first flatus, times to liquid intake, and postoperative hospital stay. The severity of gastrointestinal symptoms in the RECS group was notably better than that in the laparoscopic and open groups 3, 6, and 12 months postsurgery. Regarding long-term outcomes, there were no differences in overall or relapse-free survival among the three groups. The total hospitalization cost was significantly greater in the RECS group, primarily due to surgical cost differences. The incremental cost-effectiveness ratios per quality-adjusted life year for the RECS group relative to the laparoscopic and open groups were 18,244 and 56,914 Chinese yuan (CNY), respectively. Analysis of the cost-effectiveness acceptability curves indicated that across all willingness-to-pay thresholds, the probability that RECS was cost-effective exceeded 90%.
RECS is a safe and effective method for treating GSMTs, offering faster postoperative recovery and fewer gastrointestinal symptoms than laparoscopic and open surgeries. Despite the increased costs associated with the introduction of RECS technology, it remains a cost-effective option.
机器人与内镜协作手术（RECS）是一种新兴且有前景的治疗胃黏膜下肿瘤（GSMTs）的方法。然而，RECS的疗效尚未得到充分证实，其高昂的医疗成本显著限制了其应用。
这项巢式队列研究对采用不同手术技术治疗的GSMTs患者进行了检查。本研究共纳入314例连续患者，其中61例接受RECS治疗，196例接受腹腔镜手术治疗，57例接受开放手术治疗。为减轻混杂偏倚，采用了1:1:1倾向评分匹配（PSM）。比较了三组患者的围手术期结局、术后胃肠道症状、长期结局和成本效益。
PSM后，每组纳入51例患者。与腹腔镜手术组和开放手术组相比，RECS组术中出血量、首次排气时间、液体摄入时间和术后住院时间均显著降低。RECS组术后3、6和12个月胃肠道症状的严重程度明显优于腹腔镜手术组和开放手术组。在长期结局方面，三组患者的总生存率或无复发生存率无差异。RECS组的总住院费用显著更高，主要是由于手术费用差异。RECS组相对于腹腔镜手术组和开放手术组每质量调整生命年的增量成本效益比分别为18244元和56914元人民币（CNY）。成本效益可接受性曲线分析表明，在所有支付意愿阈值下，RECS具有成本效益的概率超过90%。
RECS是一种治疗GSMTs的安全有效方法，与腹腔镜手术和开放手术相比，术后恢复更快，胃肠道症状更少。尽管引入RECS技术会增加成本，但它仍然是一种具有成本效益的选择。
