Adoption of Technology and Its Impact on Nephrectomy Outcomes, a U.S. Population-Based Analysis (2008-2012).
Robot-assisted surgery has been touted as offering superior outcomes in various oncologic surgeries. We sought to evaluate the comparative effectiveness of robotic radical nephrectomy (RRN) compared with laparoscopic radical nephrectomy (LRN) in regard to hospital charges, complications, and survival.



Using the Surveillance Epidemiology and End Results (SEER) Program-Medicare linked database, we identified patients over the age of 65 who underwent radical nephrectomy (RN) for nonmetastatic renal-cell carcinoma from 2008 to 2012. Patients who underwent RRN were compared with those who underwent LRN. We used propensity scoring matching to compare perioperative and survival outcomes, including overall survival, cancer-specific survival, major adverse events, and healthcare charges.



Two hundred forty-one patients underwent RRN, and 574 patients underwent LRN. After propensity score matching, the adverse events rate and length of stay were similar between two groups (Major Events: 5.7% vs 6.1%, p = 0.84; prolonged LOS: 17.8% vs 16.1%, p = 0.62). The inpatient charges following RRN were significantly higher than those of LRN ($53,681 vs $44,161, p < 0.01). The mean follow-up of the cohort was 3.2 years. Estimated overall survival (88.0% vs 87.9%, p = 0.90) and cancer-specific survival (98.1% vs 96.4%, p = 0.25) were similar between the two matched cohorts at 3 years.



The robotic platform showed no benefit over standard laparoscopy for RN, as we found no difference in oncologic efficacy or adverse event rates.
1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York.
David M
DM
Golombos
1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York.
Bilal
B
Chughtai
2 Division of Urology, Brigham and Women's Hospital , Boston, Massachusetts.
Quoc-Dien
QD
Trinh
3 Department of Healthcare Policy and Research, Weill Cornell Medical College , New York, New York.
Jialin
J
Mao
1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York.
Alexis
A
Te
1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York.
Padraic
P
O'Malley
1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York.
Douglas S
DS
Scherr
1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York.
Joseph
J
Del Pizzo
1 Department of Urology, New York Presbyterian Hospital , Weill Cornell Medicine, New York, New York.
Jim C
JC
Hu
3 Department of Healthcare Policy and Research, Weill Cornell Medical College , New York, New York.
Art
A
Sedrakyan
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome; D014481:United States
cost; cost analysis; laparoscopic; nephrectomy; renal-cell carcinoma; robotic