Related Experiment Video
Updated: Aug 27, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Economic reporting and conflicts of interest in randomized trials comparing robot-assisted with laparoscopic
1School of Medicine, Kangwon National University, Chuncheon, Republic of Korea; Department of Surgery, Kangwon National University Hospital, Chuncheon, Republic of Korea.
Background:
Robot-assisted colorectal surgery carries a substantial cost premium, yet how consistently randomized trials of these platforms report economic outcomes-and whether reporting relates to industry funding or conflicts of interest-is unclear.
Methods:
We conducted a metaepidemiological systematic review (PROSPERO: CRD420261411610), searching PubMed, Embase, and Cochrane CENTRAL for randomized controlled trials comparing robot-assisted with conventional laparoscopic colorectal surgery. Reports were classified by cost-reporting tier (tier 1, none; tier 2, cost data without a formal economic evaluation; and tier 3, formal economic evaluation with an incremental cost-effectiveness ratio or quality-adjusted life-years); registries and protocols were checked for prespecified economic outcomes. The trial was the primary unit; proportions were estimated with exact 95% confidence intervals, and funding-reporting relationships were described.
Results:
Twenty-three reports of 15 trials were included. Any cost data were reported by 7 of 15 trials (46.7%; 95% confidence interval, 21.3-73.4) and a formal economic evaluation by 2 of 15 (13.3%); neither cited the Consolidated Health Economic Evaluation Reporting Standards. Four trials had a registered or protocol-documented economic outcome (2 reported, 2 deferred); most reporting no cost had not planned one. Robotic surgery was costlier in every trial reporting cost, although the scope and evidentiary strength of these comparisons varied substantially; the 2 formal evaluations reached opposite conclusions. Two trials were manufacturer funded, and 4 trials had author conflicts of interest; associations were too imprecise for inference.
Conclusion:
Within these platform trials, economic outcomes were reported inconsistently. When an economic evaluation is intended, prespecifying a cost outcome and following a standard such as Consolidated Health Economic Evaluation Reporting Standards would improve its usefulness for decision-makers.
