Robotic Cancer Surgery Better But Costlier

Kidney cancer treated with robotic partial nephrectomy offers better results but costs more

(RxWiki News) Treating kidney cancer involves surgery to remove the tumor. There are three ways this surgery is performed. A new study looked at the benefits and costs associated with all three.

Traditional open surgery involves a large incision on the side of the body. Laparoscopic – also known as minimally invasive – surgery involves four small cuts in the abdomen. And robotic-assisted surgery is performed through small incisions by a surgeon controlling robotic arms.

When the tumor only (instead of the whole kidney) is removed, the surgery is known as a partial nephrectomy.

A new study has found that robotic partial nephrectomy (RPN) involved fewer complications than open (OPN) and laparoscopic (LPN) surgeries. However, the surgery results in what the authors call “excessive” hospital charges.

"Look for a surgeon who is experienced."

Khurshid R. Ghani, MD, of Vattikuti Urology Institute and lead author of the study, said of robotic assisted surgery, “It is a safe operation that has rapidly replaced LPN as the most common minimally invasive approach for partial nephrectomy. It has shown superior results compared to open surgery, and was better than laparoscopy in every respect but cost.”

Dr. Ghani and colleagues combed through Nationwide Inpatient Sample database, which includes discharge information for 1,044 US hospitals.

Between October 2008 and December 2010, a total of 38,064 patients had surgery to treat kidney cancer that had not begun to spread.

During the study period, 70 percent of patients had open surgery, nearly 24 percent had robotic surgery and 9 percent had laparoscopic surgery.

The greatest growth in the procedures was seen in robotic surgery, which increased 45 percent over the two-year period.

Patients undergoing open surgery were more likely to need blood transfusions, and patients who had RPN were least likely to need additional blood during surgery.

Complications following surgery followed the same pattern, with the fewest complications seen among patients who had robotic surgery and the most seen among those who had open surgery.

Further, RPN surgeries were associated with the fewest complications during surgery.

The costs of robotic surgery were 38 percent higher than laparoscopic surgery and open surgery.

dailyRx News spoke to a kidney cancer expert, Alexander Kutikov, MD, associate professor of urologic surgical oncology at Fox Chase Cancer Center in Philadelphia, PA.

“The data presented by the authors is of interest; however, comparisons of patients who were pre-selected for one modality versus another have limitations and need to be interpreted with caution. For instance, patients with tumors that were better suited for nephron preservation may have been preferentially selected for robotic partial nephrectomy, thus explaining lower complication rates in that group.”

He continued, “Robotic partial nephrectomy has undoubtedly lowered barriers for minimally-invasive kidney-sparing surgery.  Indeed, today’s expert kidney surgeons are well versed in minimally invasive kidney-sparing techniques as well as open kidney surgery.

“Seeking out a urologic surgeon who is as comfortable using the robotic approach as traditional open surgery is important in order for the patient to receive a well-balanced and objective opinion regarding his/her surgical options."

A 2012 study found that robotic and laparoscopic surgery cost about $13,500. The operating room costs were higher for RPN, at $7276 versus $5708 for laparascopic. That study also found that hospital stays were shorter for RPN patients and so hospital costs were lower than those who received LPN ($4371 vs $5984). 

The findings of this study were presented May 7 at the annual meeting of the American Urological Association. Henry Ford Hospital funded the research.

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Review Date: 
May 7, 2013