Patients with rectal cancer who undergo laparoscopic or more costly robotic surgery experience faster recovery with similar clinical outcomes to open surgery, according to data presented at the American Society of Colon and Rectal Surgeons Annual Meeting in Phoenix.
Researchers evaluated 8,954 patients who underwent resection for rectal cancer, including open (86.8% of cases), laparoscopic (10.7%) and robotic (2.5%) procedures. Data was collected from the Premier database, with all procedures performed between October 2008 and June 2011. Clinical and financial outcomes, along with demographics, were assessed and compared across procedures.
Patients who underwent laparoscopic surgery had moderately severe disease according to APR-DRG more frequently than those who received open procedures (47.1% vs. 43.8%; P=.05), but less frequently had majorly (16.8% vs. 19.7%; P=.035) or extremely severe disease (4.4% vs. 6.8%; P=.005).
Overall complication rates and mortality were not significantly different among procedures, but were numerically lower in robotic cases (25.7% vs. 30.1% for open; 28.1% for laparoscopic). Transfusion was required significantly more often with open procedures than laparoscopic surgeries (17% vs. 10.8%; P<.0001), and hospital stays were longer for open procedures (8.3 ± 6.7 days) than laparoscopic (7 ± 5.6 days; P<.0001) and robotic procedures (6.7 ± 7.1 days; P=.003).
Investigators noted that hospital costs associated with robotic procedures ($23,510 ± $19,145) were significantly greater than open ($20,747 ± $19,257; P=.0005) and laparoscopic procedures ($20,196 ± $15,879; P<.0001). Hospital charges also were significantly greater for robotic procedures ($88,691 ± $103,652 vs. $67,671 ± $69,410 for open; $66,810 ± $63,718 for laparoscopic; P<.0001 for both).
“Laparoscopic and robotic rectal surgery for cancer … are viable alternatives to open surgery resulting in quicker recovery with similar clinical outcomes,” the researchers concluded. “Robotic surgery, however, results in overall higher hospital costs.”
For more information:
Haas EM. S34: The Current Status, Clinical and Financial Outcomes of Open, Laparoscopic, and Robotic Surgery for Rectal Cancer: Results from a National Database. Presented at: The American Society of Colon and Rectal Surgeons Annual Meeting 2013; April 27–May 1, Phoenix.