P1.246. Evaluating Robot-Assisted Oesophagectomy Adoption: A Comparative Single-Centre Analysis of Outcomes and Costs

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique Background Minimally invasive oesophagectomy (MIE) is widely used for oesophageal cancer, reducing tissue trauma while maintaining oncological outcomes. Robot-assisted MIE (RAMIE) offers enhanced precision and ergonomics but higher procedural costs. Its growing adoption warrants careful evaluation of cost-effectiveness with respect to overall hospital costs and resource utilisation. Methods The robotic programme was initially introduced in a hybrid format to mitigate learning-curve morbidity prior to full robotic adoption. Three consecutive cohorts undergoing minimally invasive oesophagectomy were compared: 50 conventional MIO, 50 hybrid procedures (robot-assisted thoracic phase), and 50 fully robotic cases (RAMIE). The primary outcome was total hospital cost, including index admission and unplanned 30-day readmissions, derived from institutional financial data. Procedural costs included theatre time, consumables, and equipment; staffing costs were equivalent across groups. Secondary outcomes included length of stay (ward and ITU), complications, and associated interventions. Continuous data were summarised as mean (SD) or median (IQR). Group comparisons used the Kruskal–Wallis test with post-hoc analysis where appropriate, and chi-square testing for categorical variables. Statistical significance was set at p<0.05. Results Operative duration differed significantly between groups (Kruskal–Wallis H=32.4, p<0.001), with RAMIE demonstrating the longest median operative time (414.5 min), followed by Hybrid (375 min) and MIO (285 min); post-hoc analysis confirmed significant differences across all pairwise comparisons. Length of stay also differed (H=6.92, p=0.031), with the Hybrid cohort showing longer median LOS (15.02 days) compared with MIO (10.99 days) and RAMIE (9.39 days), whereas ITU stay remained similar (p=0.726). Comprehensive Complication Index and anastomotic leak rates, including leaks > grade 1, were comparable across groups (p=0.153 and p>0.05, respectively). Consumable costs were higher in Hybrid (£5,932.32) compared with MIO (£3,923.52) and RAMIE (£3,943.35); however, overall median hospital costs remained comparable (£39,587.72, £38,443.07, and £26,375.29; p=0.57). Overall, short-term clinical outcomes were similar across approaches despite differences in operative duration and resource utilisation. Conclusion Based on our preliminary cost analysis, overall costs were comparable across Hybrid, MIO, and RAMIO approaches despite higher consumable expenses in the Hybrid group. While operative duration and length of stay differed between techniques, ITU stay, complication burden, and anastomotic leak rates were similar. These findings suggest broadly equivalent short-term clinical outcomes across approaches, with differences mainly related to operative efficiency and resource utilization, warranting further evaluation in larger prospective studies.