Clinical outcomes and cost-effectiveness analysis of robotic and endoscopic cooperative surgery for treating gastric submucosal tumors: a longitudinal nested cohort study

Abstract

Background: Robotic and endoscopic cooperative surgery (RECS) is an emerging and promising therapeutic approach for treating gastric submucosal tumors (GSMTs). However, the efficacy of RECS has not been well established, and its high medical costs significantly limit its application.

Methods: This nested cohort study examined patients with GSMTs managed with different surgical techniques. A total of 314 consecutive patients were enrolled in this study, including 61 patients treated with RECS, 196 patients treated laparoscopically, and 57 patients treated with open surgery. To mitigate confounding bias, 1:1:1 propensity score matching (PSM) was utilized. The perioperative outcomes, postoperative gastrointestinal symptoms, long-term outcomes, and cost-effectiveness among the three groups were compared.

Results: After PSM, 51 patients were included in each group. Compared with the laparoscopic and open surgical groups, the RECS group presented significantly lower intraoperative bleeding volumes, times to first flatus, times to liquid intake, and postoperative hospital stay. The severity of gastrointestinal symptoms in the RECS group was notably better than that in the laparoscopic and open groups 3, 6, and 12 months postsurgery. Regarding long-term outcomes, there were no differences in overall or relapse-free survival among the three groups. The total hospitalization cost was significantly greater in the RECS group, primarily due to surgical cost differences. The incremental cost-effectiveness ratios per quality-adjusted life year for the RECS group relative to the laparoscopic and open groups were 18,244 and 56,914 Chinese yuan (CNY), respectively. Analysis of the cost-effectiveness acceptability curves indicated that across all willingness-to-pay thresholds, the probability that RECS was cost-effective exceeded 90%.

Conclusions: RECS is a safe and effective method for treating GSMTs, offering faster postoperative recovery and fewer gastrointestinal symptoms than laparoscopic and open surgeries. Despite the increased costs associated with the introduction of RECS technology, it remains a cost-effective option.

Keywords: Clinical outcomes; Cost-effectiveness analysis; Gastric submucosal tumors; Laparoscopic surgery; Open surgery; Robotic and endoscopic cooperative surgery.

Fig. 1

Overall survival curves (A) and relapse-free survival curves (B) of patients with GSMTs according to the different surgery type

Fig. 2

Changes in gastrointestinal symptoms in the three groups after 3, 6, and 12 months of surgery. ***Significant differences between groups

Fig. 3

Radar chart of scores on 15 dimensions of GSRS questionnaire among patients with GSMTs at three months after surgery according to the different surgery type

Fig. 4

A Cost-effectiveness scatterplot of 2000 bootstrap replicates for incremental cost and incremental effectiveness of pairwise comparisons among the three groups. B The incremental cost-effectiveness ratio slope with 95% confidence interval of pairwise comparisons among the three groups

Fig. 5

A Incremental net monetary benefit with 95% confidence interval of pairwise comparisons among the three groups. B Cost-effectiveness acceptability curves of pairwise comparisons among the three groups. WTP willingness to pay