Adoption of Robotic Technology for Treating Colorectal Cancer

Abstract

Debate exists regarding the role of robotic-assisted surgery in colorectal cancer. Robotic-assisted surgery has been promoted as a strategy to increase the availability of minimally invasive surgery, which is associated with improved short-term morbidity; however, robotic-assisted surgery is much more expensive than laparoscopic surgery. We aimed to understand hospital and patient trends in the adoption of robotic-assisted surgery. The study used cross-sectional and longitudinal designs. The study included 2010 and 2012 American Hospital Association surveys, as well as the 2010-2012 Nationwide Inpatient Sample. US hospitals responding to the American Hospital Association survey were included to measure patients with colorectal cancer who were undergoing elective minimally invasive surgery or open resection. Robotic-assisted surgery adoption by US hospitals was measured, regarding specifically patients with colorectal cancer who were treated with robotic surgery. In 2010, 20.1% of hospitals adopted robotic-assisted surgery, increasing to 27.4% by 2012. Hospitals more likely to adopt robotic-assisted surgery included teaching hospitals, those with more advanced imaging services, those in metropolitan rather than rural areas, and those performing the highest inpatient surgery volume. Robotic-assisted surgery only accounted for 1.3% of colorectal cancer operations during 2010-2012, but patient probability of robotic-assisted surgery ranged from 0.1% to 15.2%. The percentage of patients with colorectal cancer who were treated robotically among those undergoing minimally invasive surgery increased over time (2010, 1.5%; 2012, 3.6%). Robotic-assisted surgery is increasing more rapidly for patients with rectal cancer with minimally invasive surgery (2010, 5.5%; 2012, 13.3%) versus patients with colon cancer treated with minimally invasive surgery (2010, 1.3%; 2012, 3.3%). The study was limited by its observational study design. Robotic-assisted surgery uptake remains low for colon cancer but higher for rectal cancer surgery, suggesting a more thoughtful adoption of robotic-assisted surgery for colorectal cancer by focusing its use on more technically challenging cases.