Robot-Assisted Surgery For Kidney Cancer Increased Access To A Procedure That Can Reduce Mortality And Renal Failure

Abstract

Surgeons increasingly use robot-assisted minimally invasive surgery for a variety of medical conditions. For hospitals, the acquisition and maintenance of a robot requires a significant investment, but financial returns are not linked to any improvement in long-term patient outcomes in the current reimbursement environment. Kidney cancer provides a useful case study for evaluating the long-term value that this innovation can provide. Kidney cancer is generally treated through partial or radical nephrectomy, with evidence favoring the former procedure for appropriate patients. We found that robot-assisted surgery increased access to partial nephrectomy and that partial nephrectomy reduced mortality and renal failure. The value of the benefits of robot-assisted minimally invasive surgery to patients, in terms of quality-adjusted life-years gained, outweighed the health care and surgical costs to patients and payers by a ratio of five to one. In addition, we found no evidence that the availability of robot-assisted minimally invasive surgery increased the likelihood that inappropriate patients received partial nephrectomy.

Toward greater adoption of minimally invasive and nephron-sparing surgical techniques for renal cell cancer in the United States

“…We found an association between higher LRN use in patients who reside in areas with a higher number of surgeons in bivariate analysis; although, this association was attenuated after adjusting for effects of other characteristics. While similar studies have reported associations between surgical trends in RCC and other health care system or provider variables (e.g., hospital, geographic region, resources within a hospital referral regions, surgery volume, physician specialty) 8,28 , our study is among the first to assess the impact of number of surgeons on LRN use.…”

“…These findings add to those from prior studies 25,26 , including an analysis using SEER-Medicare data that showed increasing use of LPN among RCC patients with tumors ≤7cm, between 1995 and 2007. Some studies suggest such growth in LPN use over time may be due, in part, to the increased use of robot-assisted LPN (RALPN) for localized tumors 27,28 . A study by Patel et al 27 of patients who underwent RN, PN, or renal ablation in the state of Maryland from 2000 to 2011, found that the increase in PN use over the study period (of 18%) was largely driven by RALPN, accounting for nearly 66% of the rise in PN.…”

“…A study by Patel et al 27 of patients who underwent RN, PN, or renal ablation in the state of Maryland from 2000 to 2011, found that the increase in PN use over the study period (of 18%) was largely driven by RALPN, accounting for nearly 66% of the rise in PN. However, with no evidence comparing oncological outcomes from RALPN to those from conventional LPN or OPN, and studies suggesting similar oncologic outcomes between LPN and OPN 29,30 , the overall increase in PN use and adoption of specific PN techniques may be driven by surgical expertise and resource capability 6,28 rather than practice guideline recommendations for RCC care.…”

Perioperative Morbidity of Open Versus Minimally Invasive Partial Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program

“…[4][5][6][7][8][9][10][11] Since the introduction and dissemination of robotic technology, the utilization of MIPN has surpassed OPN as the most common approach for PN. [12][13][14][15] However, contemporary data assessing the perioperative morbidity of OPN and MIPN are limited. Early reports describing improved perioperative outcomes with MIPN were largely limited to single institution cohorts with small sample sizes.…”

Changes in mortality associated with cancer drug approvals in the United States from 2000 to 2016

“…While focusing on a limited number of cancers affects the generalizability of our findings, the cancers considered in this study cover about 85% of all incident cancer cases 39 . Second, new treatment interventions were limited to cancer pharmaceutical interventions and did not account for non-pharmaceutical innovations, such as robotic surgery, advances in radiotherapy and other surgical techniques, which may also affect cancer mortality 80 . However, this is unlikely to affect our estimates of the association of drug innovation with cancer mortality for a number of reasons.…”