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Ferri V, Quijano Y, Nuñez J, Caruso R, Duran H, Diaz E, Fabra I, Malave L, Isernia R, d'Ovidio A, Agresott R, Gomez P, Isojo R, Vicente E. Robotic-assisted right colectomy versus laparoscopic approach: case-matched study and cost-effectiveness analysis. J Robot Surg 2020; 15:115-123. [PMID: 32367439 DOI: 10.1007/s11701-020-01084-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/24/2020] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study is to compare clinical and oncological outcomes of robot-assisted right colectomy with those of conventional laparoscopy-assisted right colectomy, reporting for the first time in literature, a cost-effectiveness analysis. METHODS This is a case-matched prospective non-randomized study conducted from October 2013 to October 2017 at Sanchinarro University Hospital, Madrid. Patients with right-sided colonic adenocarcinoma or adenoma, not suitable endoscopic resection were treated with robot-assisted right colectomy and a propensity score-matched (1:1) was used to balance preoperative characteristics of a laparoscopic control group. Perioperative, postoperative, long-term oncological results and costs were analysed, and quality-adjusted life years (QALY), and the cost-effectiveness ratio (ICER) were calculated. The primary end point was to compare the cost-effectiveness differences between both groups. A willingness-to-pay of 20,000 and 30,000 per QALY was used as a threshold to recognize which treatment was most cost effective. RESULTS Thirty-five robot-assisted right colectomies were included and a group of 35 laparoscopy-assisted right colectomy was selected. Compared with the laparoscopic group, the robotic group was associated with longer operation times (243 min vs. 179 min, p < 0.001). No significant difference was observed in terms of total costs between the robotic and laparoscopic groups (9455.14 vs 8227.50 respectively, p = 0.21). At a willingness-to-pay threshold of 20,000 and 30,000, there was a 78.78-95.04% probability that the robotic group was cost effective relative to laparoscopic group. CONCLUSION Robot-assisted right colectomy is a safe and feasible technique and is a cost-effective procedure.
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Affiliation(s)
- Valentina Ferri
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain.
| | - Yolanda Quijano
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Javier Nuñez
- IVEC (Instituto de Validación de la Eficiencia Clínica), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Riccardo Caruso
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Hipolito Duran
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Eduardo Diaz
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Isabel Fabra
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Luisi Malave
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Roberta Isernia
- Division of General Surgery, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Angelo d'Ovidio
- Division of General Surgery, Faculty of Medicine and Surgery, University of Pavia, Pavia, Italy
| | - Ruben Agresott
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Patricio Gomez
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Rigoberto Isojo
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Emilio Vicente
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
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Caruso R, Vicente E, Núñez-Alfonsel J, Ferri V, Diaz E, Fabra I, Malave L, Duran H, Isernia R, D'Ovidio A, Pinna E, Ielpo B, Quijano Y. Robotic-assisted gastrectomy compared with open resection: a comparative study of clinical outcomes and cost-effectiveness analysis. J Robot Surg 2019; 14:627-632. [PMID: 31620970 DOI: 10.1007/s11701-019-01033-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/03/2019] [Indexed: 12/21/2022]
Abstract
In the last decade, there have clearly been important changes in the surgical approach of gastric cancer treatment due to an increased interest in the minimally invasive surgical approach (MIS). The higher cost of robotic surgery procedures remains an important issue of debate. The objective of the study is to compare the main operative and clinical outcomes and to assess the incremental cost-effectiveness ratios (ICERs) of the two techniques. This is a prospective cost-effectiveness and clinical study when comparing the robotic gastrectomy (RG) technique with open gastrectomy (OG) in gastric cancer. Outcome parameters included surgical and post-operative costs, quality-adjusted life years (QALY) and incremental cost per QALY gained or the incremental cost-effectiveness ratio (ICER). The incremental utility was 0.038 QALYs and the estimated ICER for patients was dominated by robotic approach. The probability that the robotic approach was cost effective was 94.04% and 94.20%, respectively, at a WTP threshold of 20,000€ and 30,000€ per QALY gained. RG for gastric cancer represents a cost-effective procedure compared with the standard OG.
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Affiliation(s)
- Riccardo Caruso
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain. .,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain.
| | - E Vicente
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - J Núñez-Alfonsel
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - V Ferri
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - E Diaz
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - I Fabra
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - L Malave
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - H Duran
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - R Isernia
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - A D'Ovidio
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - E Pinna
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - B Ielpo
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Y Quijano
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, C/Oña nº 10, Madrid, 28050, Spain.,Instituto de Validación de la Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain
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Ferri V, Ielpo B, Duran H, Diaz E, Fabra I, Caruso R, Malave L, Plaza C, Rodriguez S, Garcia L, Perez V, Quijano Y, Vicente E. Pancreatic disease, panniculitis, polyarthrtitis syndrome successfully treated with total pancreatectomy: Case report and literature review. Int J Surg Case Rep 2016; 28:223-226. [PMID: 27736709 PMCID: PMC5065631 DOI: 10.1016/j.ijscr.2016.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/10/2016] [Accepted: 09/10/2016] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Pancreatic disease can be complicated by extrabdominal manifestations such as panniculitis and polyarthritis. The symptomatic triad comprising pancreatic disease, panniculitis and polyarthritis is also known as PPP syndrome and is characterized by severe chronic sequels and high mortality rate. We describe a case of PPP syndrome successfully treated with spleen preserving total pancreatectomy; in addition we performed a literature review. PRESENTATION OF CASE A 67 years old male presented panniculitis and polyarthritis without clinical abdominal symptoms. Clinical presentation, laboratory values and radiological findings demonstrated an acute pancreatitis and a pancreatic cancer was suspected; failure of conservatory treatments and high suspicious of malignancy led to perform a spleen preserving total pancreatectomy. Finally histological examination excluded a pancreatic cancer and confirmed a chronic pancreatitis. Patient was discharged with complete resolution of the extrabdominal disease. DISCUSSION In literature only 64 cases of PPP syndrome have been reported. Abdominal symptoms do not often appear at presentation and diagnosis may be delayed. Panniculitis develope in any part of the body but especially on the distal parts of the lower extremities, around the ankles and pretibial regions of the legs. Between osteo-articular manifestations polyarthritis is the most common one, although oligoarthritis, and monoarthritis in have been reported. CONCLUSION PPP syndrome is a rare disease with a high mortality rate. A timely diagnosis and an aggressive treatment may improve the prognosis of this condition.
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Affiliation(s)
- Valentina Ferri
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain.
| | - Benedetto Ielpo
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Hipolito Duran
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Eduardo Diaz
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Isabel Fabra
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Riccardo Caruso
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Luisi Malave
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Carlos Plaza
- Division of Anatomic Pathology, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Silvia Rodriguez
- Division of Reumathology Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Lina Garcia
- Diviasion of Nuclear Medicin, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Virginia Perez
- Division or Radiology, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Yolanda Quijano
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Emilio Vicente
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
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