Comparison of outcome and cost between the open, laparoscopic, and robotic surgical treatments for colon cancer: a propensity score-matched analysis using nationwide hospital record database

  • Chong-Chi Chiu
  • Wan-Ting Hsu
  • James J. Choi
  • Brandon Galm
  • Meng-tse Gabriel Lee
  • Chia-Na Chang
  • Chia-Yu Carolyn Liu
  • Chien-Chang LeeEmail author



There are limited studies that compare the cost and outcome of robotic-assisted surgery to open and laparoscopic surgery for colon cancer treatment. We aimed to compare the three surgical modalities for colon cancer treatment.


We performed a cohort study using the population-based Nationwide Inpatient Sample database. Patients with a primary diagnosis of colon cancer who underwent robotic, laparoscopic, or open surgeries between 2008 and 2014 were eligible for enrollment. We compared in-hospital mortality, complications, length of hospital stay, and cost for patients undergoing one of these three procedures using a multivariate adjusted logistic regression analysis and propensity score matching.


Of the 531,536 patients undergoing surgical treatment for colon cancer during the study period, 348,645 (65.6%) patients underwent open surgeries, 174,748 (32.9%) underwent laparoscopic surgeries, and 8143 (1.5%) underwent robotic surgeries. In-hospital mortality, length of hospital stay, wound complications, general medical complications, general surgical complications, and costs of the three surgical treatment modalities. Compared to those undergoing laparoscopic surgery, patients undergoing open surgery had a higher mortality rate (OR 2.98, 95% CI 2.61–3.40), more general medical complications (OR 1.77, 95% CI 1.67–1.87), a longer length of hospital stay (6.60 vs. 4.36 days), and higher total cost ($18,541 vs. $14,487) in the propensity score matched cohort. Mortality rate and general medical complications were equivalent in the laparoscopic and robotic surgery groups, but the median cost was lower in the laparoscopic group ($14641 vs. $16,628 USD).


Laparoscopic colon cancer surgery was associated with a favourable short-term outcome and lower cost compared with open surgery. Robot-assisted surgery had comparable outcomes but higher cost as compared to laparoscopic surgery.


Colon cancer Open surgery Laparoscopic surgery Robotic-assisted surgery Comparative effectiveness research Cost analysis 



The authors thank the staff of the Core Labs, the Department of Medical Research, and National Taiwan University Hospital for technical support and Medical Wisdom Consulting Group for technical assistance in statistical analysis.

Author contributions

C-CC obtained funding, and contributed to conception and design of the study, interpret the results, and write the draft. W-TH contributed to conception and design of the study, analysis and interpretation of data, critical revision, and the final draft writing. JJC, BG, M-tGL contributed to data interpretation, critical revision, and the final draft writing. C-NC, C-YCL contributed to data interpretation. C-CL had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, concept and design, critical revision of the manuscript for important intellectual content, and supervision. All authors read and approved the final manuscript.


This study is supported by the Chi Mei Medical Center, Liouying, Research Grant CLFHR10720. The sponsors had no influence in the submitted work.

Compliance with ethical standards


Chong-Chi Chiu, Wan-Ting Hsu, James J Choi, Brandon Galm, Meng-tse Gabriel Lee, Chia-Na Chang, Chia-Yu Carolyn Liu and Chien-Chang Lee have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2019_6672_MOESM1_ESM.docx (21 kb)
Appendix 1. ICD9-CM codes for the different hospital complications. Appendix 2. Empirical predictors of colon surgery and associated odds ratios. (DOCX 20 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Chong-Chi Chiu
    • 1
    • 2
  • Wan-Ting Hsu
    • 3
  • James J. Choi
    • 4
  • Brandon Galm
    • 3
  • Meng-tse Gabriel Lee
    • 5
  • Chia-Na Chang
    • 6
  • Chia-Yu Carolyn Liu
    • 7
  • Chien-Chang Lee
    • 5
    • 8
    Email author
  1. 1.Department of General SurgeryChi Mei Medical CenterTainanTaiwan, Republic of China
  2. 2.Department of Electrical EngineeringSouthern Taiwan University of Science and TechnologyTainanTaiwan, Republic of China
  3. 3.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA
  4. 4.Department of SurgeryVancouver General HospitalVancouverCanada
  5. 5.Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan, Republic of China
  6. 6.Department of Radiation OncologyWan-Fang HospitalTaipeiTaiwan, Republic of China
  7. 7.School of HealthMcTimoney College of Chiropractic, BPP UniversityAbingdonUK
  8. 8.Health Data Science Research GroupNational Taiwan University HospitalTaipeiTaiwan, Republic of China

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