Background: The incidence of colon cancer has risen in Japan in recent years. An association between insurance coverage and the use of minimally invasive surgery (MIS) has been observed. However, real-world data on this association remains limited. Furthermore, the advantages of robotic-assisted colon resection versus laparoscopic and open procedures are insufficient.

Objective: To assess outcomes of and trends in the use of robotic, laparoscopic, and open procedures for colon resection.

Methods: This retrospective cohort study utilized a nationwide Japanese inpatient database from Medical Data Vision Co., Ltd. to identify patients who underwent colon resection surgeries, including colectomy and ileostomy takedown, between January 2021 and September 2024. Inverse probability of treatment weighting (IPTW) was applied to compare length-of-stay, readmission, and postoperative complications across three surgical modalities.

Results: The MIS rate increased significantly from 77% to 82% following the implementation of insurance coverage for robotic-assisted colon resection (p trend < .001). After IPTW, the effective sample comprised 45,767 patients (1,998 robotic-assisted procedures, 34,715 laparoscopic procedures, and 9,054 open procedures) with balanced demographic and clinical characteristics. Robotic-assisted procedures were associated with shorter hospital stay (11.7 vs. 12.9 days [P<.001], and vs. 15.5 days [P<.001]), fewer 30-days readmission (1.7% vs. 2.6% [P<.01], and vs. 4.1% [P<.001]), and lower overall 30-days postoperative complications (25.0% vs. 28.1% [P<.01], and vs. 40.1% [P<.001]) compared to laparoscopic and open procedures.

Conclusions: The reimbursement policy for robotic-assisted colon resection surgery reduces insurance access disparities, MIS accessibility, and offers enhanced care options for colon cancer patients.