Achieving Quality Outcomes at reduced costs in Robotic Rectal Cancer Surgery: A Tertiary Centre's experience with 330 Robotic Rectal Cancer resections.

Rectal cancer surgery can be extremely challenging in the confines of a bony pelvis with adjoining vital structures. The male pelvis and obesity add to these challenges. Robotic systems provide surgeons with enhanced dexterity, precision, and visualization, making them particularly suitable for Rectal cancer surgeries. The major challenge with a robotic platform is additional per patient cost for using the robotic system, instruments and maintenance. To address this, we have standardized three important aspects of Rectal surgery. Firstly, through sub specialization of the surgeon in Rectal surgery, secondly standardization of the Robotic TME technique and thirdly by taking steps to reduce associated costs without compromising patient outcomes. The aim of this retrospective study was to assess if we can improve surgical outcomes while achieving cost efficiency in Robotic Rectal Cancer surgery. The early surgical outcomes like anastomotic leak, surgical site infection, readmission, re-exploration, margin positivity, and length of stay are comparable (sometimes even better) in our study as compared to the robotic group of ACS-NSQIP(American College of Surgeons National Surgical Quality Improvement Program) study. Additionally, our average cost of INR 450,315 ($ 5122.10) is significantly lower than the national range of INR 500, 000 to INR 1,000,000 ($ 5687.2 to $11374.4) for Robotic Rectal Cancer surgery. This study demonstrates that by adopting subspecialisation, standardising technique and implementing cost saving measures we can deliver favourable outcomes in Rectal cancer surgery and, do so cost effectively. This in turn opens the opportunity for wide spread use of Robotic Rectal Cancer surgery.