266 Cost Effectiveness of Implementation of Robotic-Assisted vs Laparoscopic/open Oesphagectomy Within Our Center

Abstract Aim Robotic-assisted trans-thoracic oesophagectomy (TTO) is increasingly adopted in the UK, with potential to reduce cardiorespiratory and major complications. However, its cost-effectiveness within the NHS remains underreported. To evaluate hospital costs associated with robotic assisted (abdominal phase) TTO compared with laparoscopic and open approaches for oesophageal cancer. Method A retrospective analysis of 115 patients underwent oesophagectomy between January 2023 and October 2024 was conducted. Patients were grouped by surgical technique: robotic assisted (n=28), laparoscopic (n=15), and open (n=72). The primary outcome was total hospital cost from surgery to discharge, including theatre, ICU, ward, diagnostics, and indirect expenses. Secondary outcomes included operative duration, complication rates, and cost-influencing factors. Results Robotic-assisted surgery had a significantly lower average hospital cost than laparoscopic or open surgery (£16,777 vs. £24,932, p=0.02). Operative duration was comparable (333 vs. 318 minutes, p=0.17). Median length of stay was shorter in the robotic group (8 vs. 10 days, p=0.09), with fewer cardiorespiratory complications (18% vs. 29%, p=0.089). Major complications (Clavien-Dindo ≥3) and unplanned ITU readmissions were lower with robotic surgery and identified as primary cost drivers across all groups. When excluding CD3+ complications, there was a further cost reduction trend in the robotic cohort (£15,526 vs. £18,719, p=0.09). Conclusions Robotic-assisted TTO offers cost savings and favourable perioperative outcomes compared to laparoscopic and open surgery in the NHS. Ensuring low complication rates is key to maximizing cost-effectiveness. Expansion of robotic use to include the thoracic phase may offer additional benefits.