Robotic surgery in gastrointestinal cancers: short-term clinical outcomes and micro-costing analysis from a reference oncologic center.

BACKGROUND

Robotic Surgery (RS) adoption in public healthcare is limited by high costs. The authors evaluated clinical outcomes and micro-costs of RS for Gastrointestinal (GI) cancers at a Brazilian reference center.

METHODS

A prospective, randomized trial (NCT02292914) compared RS (da Vinci Si) to a mixed comparator arm (laparoscopic/open) for esophagectomy, gastrectomy, and rectal resection. Primary outcomes were Length of Stay (LOS) and per-patient operative costs. Micro-costing followed national guidelines, including deterministic and probabilistic sensitivity analyses. Analyses followed the intention-to-treat principle.

RESULTS

The authors analyzed 135 patients (65 RS, 70 control). RS significantly reduced LOS in esophagectomy (14.7 ± 8.2 vs. 20.3 ± 7.4 days, p < 0.001) and rectal resection (8.9 ± 2.1 vs. 10.0 ± 2.5 days, p < 0.05); gastrectomy LOS was similar (11.3 ± 3.8 vs. 11.5 ± 4.1). Estimated blood loss decreased by > 50% across all RS procedures (p < 0.05). Oncologic adequacy (R0 rates and lymph node yield) was comparable between groups. No significant differences in major complications occurred. RS increased per-patient incremental costs: esophagectomy +US$ 3,018; gastrectomy +US$ 2,816; and rectal resection +US$ 1,470, with a pooled GI incremental cost of +US$ 2,326 (95% CrI: 1,718-2,944). Proprietary instruments were the primary cost drivers.

CONCLUSIONS

Robotic GI surgery reduces LOS and blood loss with oncologic outcomes comparable to conventional approaches. However, it carries a significant cost premium (approx. US$ 2,326/case). Whether these clinical gains justify the investment within the public system requires further multicenter studies incorporating long-term quality-of-life data.