Robotic Surgery in Oncology: Results From a Multidimensional Assessment in Italy

OBJECTIVES: To define the incremental benefits concerning a higher implementation of robotic surgery with respect to laparoscopy, assuming the hospital perspective, within the colorectal, gastric, esophageal, and pancreatic surgical settings.

METHODS: A Health Technology Assessment, grounded on the AdHopHTA framework, was conducted in 2023/2024. Different data sources were utilized: i) literature evidence, to define efficacy and safety comparative indicators, considering both surgical approaches; ii) real-world data, derived from a large-size Italian hospital, collecting anonymous hospital data flows to economically valorize the surgical pathways; and iii) healthcare professionals’ perceptions, defining the perceived added value of robotic versus laparoscopic surgery, based on an evaluation scale ranging from -3 to +3.

RESULTS: Literature declared a superimposable safety profile, despite a higher efficacy (% patients requiring a conversion to open surgery) emerged in most surgical settings.

From an economic perspective, an advantage is reported, except for gastric surgeries, leading to a general modification of costs per patient ranging from +7% to -9%. Over a 6-month time horizon, in the conduction of 131 surgical procedures, a higher use of robotic surgery would lead to a general hospital economic saving equal to 3% (-39,677 €), thus also generating significant organizational savings, in terms of reduction in the hospitalization days (-22%; -516 days). This feature would decrease the overall patients’ productivity loss by on average 26%.

Healthcare professionals’ perceptions confirmed the superiority of robotic surgery, declaring a better occupational safety (0.60 vs -0.04, p-value=0.031) and effectiveness profile (1.62 vs -1.00, p-value=0.048). They also confirmed the potentialities of robotic surgery to improve patients’ satisfaction (2.33 vs 1.67, p-value=0.022), and to optimize both the patients’ post-operative pain (2.11 vs 1.33, p-value=0.033).

CONCLUSIONS: Results showed the strategic relevance related to robotic surgery routinely implementation in the surgical practice, demonstrating its hospital economic and organizational sustainability, with important advantages for patients.