Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

Abstract

Background: Enhanced recovery after surgery (ERAS) pathways are beneficial in proctocolectomy, but their impact on robotic low rectal proctectomy is not fully investigated. This study assessed the impact of an ERAS pathway on the outcomes and cost of robotic (RTME) versus laparoscopic (LTME) total mesorectal excision.Methods: A retrospective review was performed of patients with rectal cancer in a single French tertiary centre for three yearly periods: 2011, LTME; 2015, RTME; and 2018, RTME with ERAS. Patient characteristics, operative and postoperative data, and costs were compared among the groups.Results: A total of 220 consecutive proctectomies were analysed (71 LTME, 58 RTME and 91 RTME with ERAS). A prevalence of lower and locally advanced tumours was observed with RTME. The median duration of surgery increased with the introduction of RTME, but became shorter than that for LTME with greater robotic experience (226, 233 and 180 min for 2011, 2015 and 2018 respectively; P < 0⋅001). The median duration of hospital stay decreased significantly for RTME with ERAS (11, 10 and 8 days respectively; P = 0⋅011), as did the overall morbidity rate (39, 38 and 16 per cent; P = 0⋅002). Pathology results, conversion and defunctioning stoma rates remained stable. RTME alone increased the total cost by €2348 compared with LTME. The introduction of ERAS and improved robotic experience decreased costs by €1960, compared with RTME performed in 2015 without ERAS implementation. In patients with no co-morbidity, costs decreased by €596 for RTME with ERAS versus LTME alone. Conclusion: ERAS is associated with cost reductions in patients undergoing robotic proctectomy.

Robotic surgery for colorectal cancer

“…Various systematic reviews of the literature agree that robotic surgery is associated with a significantly shorter time to oral diet tolerance or first flatus in patients with colorectal cancer 19,20,23 . When associated with ERAS protocols, robotic surgery seems to have an added value in this field 24,25 …”

Enhanced Recovery after Uterine Corpus Cancer Surgery: A 10 Year Retrospective Cohort Study of Robotic Surgery in an NHS Cancer Centre

“…The reduction in post-operative 30 day complication rate by performing robotic procedures on these patients has also demonstrated a cost saving of £763 vs. open and £161 vs. laparoscopic procedures. Due to the reduction in conversion rates cost modelling revealed a potential saving for £671 when comparing robotic vs. laparoscopic procedures [ 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Following the introduction of extended user pricing by Intuitive surgical ltd since 2020 the cost of each robotic assisted procedure has reduced further by £219.…”

Should minimally invasive approaches in rectal surgery be regarded as a key element of modern enhanced recovery perioperative care?

“…The perineal wound is prone to healing complications, particularly in patients after neoadjuvant treatment [14]. In some centres, abdominoperineal resections are excluded from ERAS protocols [15]. Patients with stomas have to be educated by a stoma care nurse before discharge on how to take care of their stomas and patients with ileostomies are prone to electrolyte abnormalities for a variable period of time in the immediate postoperative period and can only be discharged after this has normalised.…”