Utilization and Patient Characteristics of Robotic-Assisted Colorectal Surgery in Germany: A Claims Data Analysis
Author(s)
Joana Pestana, PhD1, Kathrin Gerchow, MPH2, Janina Röhrkaste, MSc2, Christian Jacob, PhD2, James Lavin, MSc3.
1Intuitive Surgical Deutschland GmbH, Freiburg, Germany, 2Cencora, Hannover, Germany, 3Intuitive Surgical, Aubonne, Switzerland.
1Intuitive Surgical Deutschland GmbH, Freiburg, Germany, 2Cencora, Hannover, Germany, 3Intuitive Surgical, Aubonne, Switzerland.
OBJECTIVES: Colorectal cancer (CRC) is among the most common cancers in Germany, with 54,610 new cases and 22,670 deaths reported in 2022. Surgery remains a cornerstone of treatment, with increasing adoption of robotic-assisted surgery (RAS). This study examines CRC patients undergoing RAS in Germany, analyzing variations in patient, hospital, and procedural characteristics across surgical techniques to inform healthcare resource allocation and equity.
METHODS: A retrospective claims data analysis using the InGef research database was conducted, covering ~5% of the German population (~4 million individuals) from 2016 to 2023. Eligible patients had a prior CRC diagnosis, no other primary tumors, and continuous observability one year pre- and post-surgery. Demographic, clinical, hospital, and regional variations across surgical techniques (open, laparoscopic, RAS) and procedures (sigmoid colectomy, right/left hemicolectomy, rectal resection) were analyzed.
RESULTS: In total, 1,504 patients with sigmoid colectomy, 5,280 right and 1,121 left hemicolectomy, and 4,077 rectal resection were identified. RAS was most frequently used for rectal resections (6.8%), followed by sigmoid colectomy (2.3%), right hemicolectomy (2.1%), and left hemicolectomy (1.3%). RAS patients were consistently younger than those undergoing open surgery (e.g., 7.4 years younger on average for left hemicolectomy, 5.7 for sigmoid, and 4.6 for rectal resection), predominantly male and had fewer comorbidities. However, for rectal resection, RAS patients had higher mean CCI scores compared to open and laparoscopic surgery (3.8 vs. 3.5 vs. 3.1), suggesting selective use for complex cases. Most procedures were conducted in non-teaching hospitals (e.g., 73.3% left hemicolectomy, 56.3% rectal resection). Geographic place of living was mainly urban western Germany.
CONCLUSIONS: RAS has seen modest but growing uptake in Germany, particularly for rectal cancer, with predominant use in younger, healthier patients, likely reflecting surgical risk stratification or technology availability. Significant regional and institutional disparities highlight access inequities. Ongoing research will evaluate long-term patient outcomes, healthcare utilization, and cost-effectiveness.
METHODS: A retrospective claims data analysis using the InGef research database was conducted, covering ~5% of the German population (~4 million individuals) from 2016 to 2023. Eligible patients had a prior CRC diagnosis, no other primary tumors, and continuous observability one year pre- and post-surgery. Demographic, clinical, hospital, and regional variations across surgical techniques (open, laparoscopic, RAS) and procedures (sigmoid colectomy, right/left hemicolectomy, rectal resection) were analyzed.
RESULTS: In total, 1,504 patients with sigmoid colectomy, 5,280 right and 1,121 left hemicolectomy, and 4,077 rectal resection were identified. RAS was most frequently used for rectal resections (6.8%), followed by sigmoid colectomy (2.3%), right hemicolectomy (2.1%), and left hemicolectomy (1.3%). RAS patients were consistently younger than those undergoing open surgery (e.g., 7.4 years younger on average for left hemicolectomy, 5.7 for sigmoid, and 4.6 for rectal resection), predominantly male and had fewer comorbidities. However, for rectal resection, RAS patients had higher mean CCI scores compared to open and laparoscopic surgery (3.8 vs. 3.5 vs. 3.1), suggesting selective use for complex cases. Most procedures were conducted in non-teaching hospitals (e.g., 73.3% left hemicolectomy, 56.3% rectal resection). Geographic place of living was mainly urban western Germany.
CONCLUSIONS: RAS has seen modest but growing uptake in Germany, particularly for rectal cancer, with predominant use in younger, healthier patients, likely reflecting surgical risk stratification or technology availability. Significant regional and institutional disparities highlight access inequities. Ongoing research will evaluate long-term patient outcomes, healthcare utilization, and cost-effectiveness.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE746
Topic
Economic Evaluation, Medical Technologies, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Gastrointestinal Disorders, Oncology