Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy.

Background Enhanced recovery after surgery (ERAS) pathways are beneficial in proctocolectomy, but their impact on robotic low rectal proctectomy is not fully investigated. This study assessed the impact of an ERAS pathway on the outcomes and cost of robotic (RTME) versus laparoscopic (LTME) total mesorectal excision. Methods A retrospective review was performed of patients with rectal cancer in a single French tertiary centre for three yearly periods: 2011, LTME; 2015, RTME; and 2018, RTME with ERAS. Patient characteristics, operative and postoperative data, and costs were compared among the groups. Results A total of 220 consecutive proctectomies were analysed (71 LTME, 58 RTME and 91 RTME with ERAS). A prevalence of lower and locally advanced tumours was observed with RTME. The median duration of surgery increased with the introduction of RTME, but became shorter than that for LTME with greater robotic experience (226, 233 and 180 min for 2011, 2015 and 2018 respectively; P < 0 center dot 001). The median duration of hospital stay decreased significantly for RTME with ERAS (11, 10 and 8 days respectively; P = 0 center dot 011), as did the overall morbidity rate (39, 38 and 16 per cent; P = 0 center dot 002). Pathology results, conversion and defunctioning stoma rates remained stable. RTME alone increased the total cost by euro2348 compared with LTME. The introduction of ERAS and improved robotic experience decreased costs by euro1960, compared with RTME performed in 2015 without ERAS implementation. In patients with no co-morbidity, costs decreased by euro596 for RTME with ERAS versus LTME alone. Conclusion ERAS is associated with cost reductions in patients undergoing robotic proctectomy.