In recent decades, robotic-assisted minimally invasive esophagectomy (RAMIE) has been increasingly adopted for patients with esophageal cancer (EC) or cancer of the gastroesophageal junction (GEJ). However, concerns regarding its costs compared to conventional minimally invasive esophagectomy (MIE) have emerged. This study examined outcomes and costs of RAMIE versus total MIE in 128 patients who underwent Ivor Lewis esophagectomy for EC/GEJ at our department between 2017 and 2021. Surgical costs were higher for RAMIE (EUR 12,370 vs. EUR 10,059,p< 0.001). Yet, median daily (EUR 2023 vs. EUR 1818,p= 0.246) and total costs (EUR 30,510 vs. EUR 29,180,p= 0.460) were comparable. RAMIE showed a lower incidence of postoperative pneumonia (8% vs. 25%,p= 0.029) and a trend towards shorter hospital stays (15 vs. 17 days,p= 0.205), which may have equalized total costs. Factors independently associated with higher costs included readmission to the intensive care unit (hazard ratio [HR] = 7.0), length of stay (HR = 13.5), anastomotic leak (HR = 17.0), and postoperative pneumonia (HR = 5.4). In conclusion, RAMIE does not impose an additional financial burden. This suggests that RAMIE may be considered as a valid alternative approach for esophagectomy. Attention to typical cost factors can enhance postoperative care across surgical methods.
近几十年来，机器人辅助微创食管切除术（RAMIE）在食管癌（EC）或胃食管结合部癌（GEJ）患者中的应用日益广泛。然而，与传统微创食管切除术（MIE）相比，其成本问题逐渐受到关注。本研究分析了2017年至2021年间在我科接受Ivor Lewis食管切除术的128例EC/GEJ患者，比较了RAMIE与全MIE的临床结果及费用。RAMIE的手术成本较高（12,370欧元 vs. 10,059欧元，p<0.001），但中位日均费用（2023欧元 vs. 1818欧元，p=0.246）和总费用（30,510欧元 vs. 29,180欧元，p=0.460）相当。RAMIE组术后肺炎发生率较低（8% vs. 25%，p=0.029），且住院时间呈缩短趋势（15天 vs. 17天，p=0.205），这可能抵消了总费用差异。与更高费用独立相关的因素包括重症监护病房再入院（风险比[HR]=7.0）、住院时间（HR=13.5）、吻合口漏（HR=17.0）和术后肺炎（HR=5.4）。综上所述，RAMIE并未增加额外经济负担，表明其可作为食管切除术的有效替代方案。关注典型成本驱动因素有助于优化不同手术方式的术后护理。
肿瘤(癌症)患者之家