Adoption of robotic technology for treating colorectal cancer

BACKGROUND: Debate exists regarding the role of robotic-assisted surgery in colorectal cancer. Robotic-assisted surgery has been promoted as a strategy to increase the availability of minimally invasive surgery, which is associated with improved short-term morbidity; however, robotic-assisted surgery is much more expensive than laparoscopic surgery. OBJECTIVE: We aimed to understand hospital and patient trends in the adoption of robotic-assisted surgery. DESIGN: The study used cross-sectional and longitudinal designs. SETTINGS: The study included 2010 and 2012 American Hospital Association surveys, as well as the 2010-2012 Nationwide Inpatient Sample. PATIENTS: US hospitals responding to the American Hospital Association survey were included to measure patients with colorectal cancer who were undergoing elective minimally invasive surgery or open resection. MAIN OUTCOME MEASURES: Robotic-assisted surgery adoption by US hospitals was measured, regarding specifically patients with colorectal cancer who were treated with robotic surgery. RESULTS: In 2010, 20.1% of hospitals adopted robotic-assisted surgery, increasing to 27.4% by 2012. Hospitals more likely to adopt robotic-assisted surgery included teaching hospitals, those with more advanced imaging services, those in metropolitan rather than rural areas, and those performing the highest inpatient surgery volume. Robotic-assisted surgery only accounted for 1.3% of colorectal cancer operations during 2010-2012, but patient probability of robotic-assisted surgery ranged from 0.1% to 15.2%. The percentage of patients with colorectal cancer who were treated robotically among those undergoing minimally invasive surgery increased over time (2010, 1.5%; 2012, 3.6%). Robotic-assisted surgery is increasing more rapidly for patients with rectal cancer with minimally invasive surgery (2010, 5.5%; 2012, 13.3%) versus patients with colon cancer treated with minimally invasive surgery (2010, 1.3%; 2012, 3.3%). LIMITATIONS: The study was limited by its observational study design. CONCLUSIONS: Robotic-assisted surgery uptake remains low for colon cancer but higher for rectal cancer surgery, suggesting a more thoughtful adoption of robotic-assisted surgery for colorectal cancer by focusing its use on more technically challenging cases.