Increasing robotic rectal cancer surgery may not increase total hospital costs

BACKGROUND: The robotic approach provides fewer conversions and complications as well as better post-operative functionality in rectal surgery but increased costs in randomized trials has limited its use. The aim of this study was to compare the total hospital costs of rectal cancer surgery following the introduction of a second robotic platform. METHODS: Consecutive patients who underwent open, laparoscopic or robotic rectal cancer resection between March 2020 and February 2023 were retrospectively collected from patient registry. Time periods represented 18 months before and 18 months after the introduction of second robotic system. Outcomes and 90-day hospital costs of 3/2020-8/2021 (Group1) and 9/2021-2/2023 (Group2) were compared. RESULTS: Total cohort included 227 patients, 105 in Group1 and 122 in Group2. No significant differences were observed in ASA-class, Tumor-location, -stage or co-morbidity. Operative blood loss and operative time were similar. Increased robotic access changed the allocation of surgical modalities (p < 0.001) and increased the share of patients operated mini-invasively (83% vs. 93%, p = 0.038), also major complications decreased (48% vs. 37%, p = 0.041). Mean operative costs were higher in Group2 (13 350 vs. 12 819 €) but mean 90-d total hospital costs were lower (23 777 vs. 24 875 €, non-significant). CONCLUSION: Increased robotic access changed the allocation of surgical modalities in rectal cancer surgery. Although, new robotic platform increased direct operative costs, total 90-d hospital costs did not rise due to compensatory decreases in other segments of the treatment. Therefore, increasing robotic surgery may not increase total hospital costs of rectal cancer surgery.