Index cost comparison of laparoscopic vs robotic surgery in colon and rectal cancer resection: a retrospective financial investigation of surgical methodology innovation at a single institution.

Abstract

Robotic assisted colorectal cancer resection (R-CR) has become increasingly commonplace in contrast to traditional laparoscopic cancer resection (L-CR). The aim of this study was to compare the total direct costs of R-CR to that of L-CR and to compare the groups with respect to costs related to LOS. Patients who underwent colon and/or rectal cancer resection via R-CR or L-CR instrumentation between January 1, 2015 and December 31 2018, at our institution, were evaluated and compared. Primary outcomes were overall cost, supply cost, operating time and cost, postoperative length of stay (LOS), and postoperative LOS cost. Secondary outcomes were readmission within 30days and mortality during the surgery. Two hundred forty R-CR (mean age 64.9 ± 12.4years) and 258 L-CR (mean age 66.4 ± 15.5years) patients met the inclusion criteria. The overall mean direct cost between R-CR and L-CR was significantly higher ($8756 vs $7776 respectively, p=0.001) as well as the supply cost per case ($3789 vs $2122, p < 0.001). Operating time was also higher for R-CR than L-CR (224min vs 187min, p = 0.066) but LOS was slightly lower (5.08days vs 5.55days, p = 0.113). Cost is the main obstacle to easy and widespread use of the platform at this junction, though new developments and competition could very well reduce costs. Supply cost was the main reason for increased costs with robotic resection.