Browsing by Author "Li, Mo Yu L."

Now showing 1 - 1 of 1
  • Thumbnail Image
    ItemOpen Access
    A Cost-Utility Analysis of Robotic vs. Laparoscopic-assisted Rectal Cancer Resection
    (2022-06-17) Li, Mo Yu L.; Dixon, Elijah; Crump, Robert T.; Datta, Indraneel; Rennert-May, Elissa
    Robotic-assisted colorectal surgery is a novel minimally invasive approach to cancers of the rectum and rectosigmoid. Compared to the more established laparoscopic-assisted technique, the robotic platform offers three-dimensional visualization and greater degrees of instrument mobility. While the robotic technique has gained widespread use in the United States and Europe, implementation in Canada remains limited due to high costs. Although there is some evidence for improved robotic outcomes, there is minimal reporting of Canadian outcomes after robotic rectal and rectosigmoid cancer resection. Further, there is a paucity of economic evaluations informing the cost-effectiveness of robotic rectal cancer resection. We assessed clinicopathologic outcomes and surgeon learning curve associated with robotic-assisted rectal and rectosigmoid cancer resection in an Alberta setting. We then systematically reviewed existing economic evaluations on robotic-assisted colorectal surgery. Finally, we performed a cost-utility analysis to inform the robotic technology’s cost-effectiveness compared to the laparoscopic approach in rectal cancer care. Our Canadian outcomes study included 67 patients who underwent robotic-assisted rectal and rectosigmoid cancer resection in Alberta’s first robotic colorectal surgery program. We found that the Alberta clinicopathologic results are comparable to existing international studies despite surgeons in the Alberta program being robotic novices at the start of the series. Robotic operating time decreased significantly as surgeon experience increased. We found four economic evaluations in the literature reporting on cost-effectiveness of robotic-assisted colorectal surgery. Two studies found it to be cost-effective whereas the other two found the contrary. Due to significant inter-study heterogeneity and contradicting results, there is no definitive conclusion to robotic cost-effectiveness without further research. Our cost-utility analysis found that robotic-assisted rectal cancer surgeon is cost-effective compared to the laparoscopic approach at a Canadian cancer care-specific cost-effectiveness threshold of CAD $100,000, assuming high case volumes on the robot. The wider adoption of robotic technology in Canadian rectal cancer care should be considered at high volume centres.