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Comparison of robotic versus laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a prospective trial-based economic evaluation

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Abstract

Importance

It is largely unclear whether robotic distal gastrectomy (RDG) is cost-effective for locally advanced gastric cancer (LAGC).

Objective

To evaluate the cost-effectiveness of RDG, laparoscopic distal gastrectomy (LDG), and open distal gastrectomy (ODG) for patients with LAGC.

Design, setting, and participants

Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. A decision-analytic model was constructed to evaluate the cost-effectiveness of RDG, LDG, and ODG.

Exposures

RDG, LDG, and ODG.

Main outcomes and measures

Incremental cost-effectiveness ratio (ICER) and quality-adjusted life year (QALY).

Results

This pooled analysis of two randomized controlled trials included 449 patients: 117, 254, and 78 patients in the RDG, LDG, and ODG groups, respectively. After IPTW, RDG demonstrated its priority in terms of less blood loss, postoperative length, and complication rate (all P < 0.05). RDG also showed higher QOL with more cost, representing an ICER of $85,739.73 per QALY and $42,189.53 per QALY compared to LDG and ODG, respectively. In probabilistic sensitivity analysis, RDG achieved the best cost-effectiveness for patients with LAGC only when the willingness-to-pay threshold was > $85,739.73 per QALY, which significantly exceeded 3 times Chinese per capita GDP. Furthermore, one of the most important factors was the indirect costs of robotic surgery in terms of the cost-effectiveness of RDG compared to that of LDG or ODG.

Conclusions and relevance

Although improved short-term outcomes and QOL were seen in patients underwent RDG, the economic burden should be considered in the clinical decision-making regarding robotic surgery use for patients with LAGC. Our findings may vary in different health care settings and affordability.

Trial registration CLASS-01 trial (ClinicalTrials.gov, CT01609309) and FUGES-011 trial (ClinicalTrials.gov, NCT03313700).

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank all colleagues and nurses who provided patient care. We also thank all the family members (Chungui Ke et al.) who are supporting us. We hope that our contribution will be positive for LAGC patients.

Funding

This study was funded by Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare.

Author information

Author notes

  1. Jun Lu, Dong Wu, and Jiao-bao Huang contributed equally to this work and should be considered co-first author.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China

    Jun Lu, Dong Wu, Jiao-bao Huang, Jia Lin, Bin-bin Xu, Zhen Xue, Hua-Long Zheng, Guo-sheng Lin, Li-li Shen, Ping Li, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-Long Cao, Jian-Wei Xie, Chao-Hui Zheng & Chang-Ming Huang

  2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Jun Lu, Dong Wu, Jiao-bao Huang, Jia Lin, Bin-bin Xu, Zhen Xue, Hua-Long Zheng, Guo-sheng Lin, Li-li Shen, Ping Li, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-Long Cao, Jian-Wei Xie, Chao-Hui Zheng & Chang-Ming Huang

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Contributions

Conception/Design: JL, DW, C-MH and C-HZ. Collection and/or assembly of data: JL, DW, J-bH, B-bX, ZX, H-LZ, G-sL, JL, L-lS, J-WX, J-BW, J-XL, Q-YC, L-LC, PL, C-HZ, C-MH. Data analysis and interpretation: DW, JL, ZX, B-bX, J-bH, H-LZ, PL, C-HZ, C-MH. Manuscript writing: DW, JL, J-bH, C-MH and C-HZ. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Chao-Hui Zheng or Chang-Ming Huang.

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Disclosures

Jun Lu, Dong Wu, Jiao-bao Huang, Jia Lin, Bin-bin Xu, Zhen Xue, Hua-Long Zheng, Guo-sheng Lin, Li-li Shen, Ping Li, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-Long Cao, Jian-Wei Xie, Chao-Hui Zheng, and Chang-Ming Huang have no conflicts of interest or financial ties to disclose.

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Lu, J., Wu, D., Huang, Jb. et al. Comparison of robotic versus laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a prospective trial-based economic evaluation. Surg Endosc 37, 7472–7485 (2023). https://doi.org/10.1007/s00464-023-10147-1

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