A comparative cost analysis of transanal and laparoscopic total mesorectal excision for rectal cancer.
Aged
Costs and Cost Analysis
Digestive System Surgical Procedures
/ economics
Female
Health Resources
/ economics
Humans
Laparoscopy
/ economics
Length of Stay
/ economics
Male
Middle Aged
Perioperative Care
/ economics
Postoperative Complications
/ economics
Rectal Neoplasms
/ economics
Treatment Outcome
Cost analysis
Laparoscopic total mesorectal excision (lapTME)
Rectal cancer
Total mesorectal excision (TME)
Transanal total mesorectal excision (taTME)
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
25
06
2020
accepted:
30
08
2020
pubmed:
16
9
2020
medline:
4
8
2021
entrez:
15
9
2020
Statut:
ppublish
Résumé
Despite proven clinical benefits in the short term, technical difficulties limit utilization of laparoscopy in rectal cancer surgery (RCS). Transanal Total Mesorectal Excision (taTME) overcomes many technical limitations of laparoscopic RCS. However, the costs of this procedure have not been addressed yet. Our goal was to perform a comparative cost analysis of taTME and laparoscopic TME (lapTME). Consecutive patients undergoing curative TME between 1 February 2014 and 31 October 2018 were selected from a prospectively maintained database and stratified, according to the type of procedure, into taTME and lapTME groups. Patient demographics, tumour characteristics, operative parameters, and short-term outcomes were analyzed. The main outcome measure was intraoperative costs of the two procedures. Secondary outcomes were short-term outcome and the utilization of hospital resources to manage the postoperative course. Hundred and fifty-two patients with rectal cancer (66 lapTME, 86 taTME) were included in the study. Surgical supplies required for taTME procedure exceeded the cost of lapTME of 754,54 €. The duration of surgery was not significantly different between the two approaches (266 ± 92.85 vs 271 ± 83.63, p = 0.50). Short-term outcomes were comparable including postoperative complication rate (17 vs 20%, p = 0.68), reintervention rate, and length of stay. There was no difference in hospital resources utilization to manage postoperative course including blood test, diagnostics, consultations, and medications. TaTME has higher intraoperative costs in terms of supplies with respect to lapTME. Short-term outcomes and hospital resources to manage postoperative course are comparable.
Identifiants
pubmed: 32929690
doi: 10.1007/s13304-020-00879-3
pii: 10.1007/s13304-020-00879-3
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
85-91Références
Nelson H, Sargent DJ, Wieand HS et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. https://doi.org/10.1056/NEJMoa032651
doi: 10.1056/NEJMoa032651
pubmed: 15559963
Lacy AM, García-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. https://doi.org/10.1016/S0140-6736(02)09290-5
doi: 10.1016/S0140-6736(02)09290-5
pubmed: 12103285
Heikkinen T, Msika S, Desvignes G et al (2005) Laparoscopic surgery versus open surgery for colon cancer: Short-term outcomes of a randomised trial. Lancet Oncol. https://doi.org/10.1016/S1470-2045(05)70221-7
doi: 10.1016/S1470-2045(05)70221-7
Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J Clin Oncol. https://doi.org/10.1200/JCO.2006.09.7758
doi: 10.1200/JCO.2006.09.7758
pubmed: 17634484
Keller DS, Delaney CP, Hashemi L, Haas EM (2016) A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery. Surg Endosc. https://doi.org/10.1007/s00464-015-4732-6
doi: 10.1007/s00464-015-4732-6
pubmed: 28008470
Dowson HM, Huang A, Soon Y et al (2007) Systematic review of the costs of laparoscopic colorectal surgery. Dis Colon Rectum. https://doi.org/10.1007/s10350-007-0234-5
doi: 10.1007/s10350-007-0234-5
pubmed: 17468985
Jeong SY, Park JW, Nam BH et al (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. https://doi.org/10.1016/S1470-2045(14)70205-0
doi: 10.1016/S1470-2045(14)70205-0
pubmed: 24837215
Bonjer HJ, Deijen CL, Abis GA et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. https://doi.org/10.1056/NEJMoa1414882
doi: 10.1056/NEJMoa1414882
pubmed: 26154803
Keller DS, Qiu J, Senagore AJ (2018) Predicting opportunities to increase utilization of laparoscopy for rectal cancer. Surg Endosc. https://doi.org/10.1007/s00464-017-5844-y
doi: 10.1007/s00464-017-5844-y
pubmed: 30334153
Heald RJ, Santiago I, Pares O et al (2017) The perfect total mesorectal excision obviates the need for anything else in the management of most rectal cancers. Clin Colon Rectal Surg. https://doi.org/10.1055/s-0037-1606109
doi: 10.1055/s-0037-1606109
pubmed: 29184467
pmcid: 5703664
Quirke P, Steele R, Monson J et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. https://doi.org/10.1016/S0140-6736(09)60485-2
doi: 10.1016/S0140-6736(09)60485-2
pubmed: 19269520
pmcid: 2668948
Nagtegaal ID, Van de Velde CJH, Van Der Worp E et al (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. https://doi.org/10.1200/JCO.2002.07.010
doi: 10.1200/JCO.2002.07.010
pubmed: 11919228
Bondeven P, Hagemann-Madsen RH, Laurberg S, Pedersen BG (2013) Extent and completeness of mesorectal excision evaluated by postoperative magnetic resonance imaging. Br J Surg. https://doi.org/10.1002/bjs.9225
doi: 10.1002/bjs.9225
pubmed: 23939848
Emile SH, de Lacy FB, Keller DS et al (2018) Evolution of transanal total mesorectal excision for rectal cancer: From top to bottom. World J Gastrointest Surg. https://doi.org/10.4240/wjgs.v10.i3.28
doi: 10.4240/wjgs.v10.i3.28
pubmed: 29588809
pmcid: 5867456
Penna M, Hompes R, Arnold S et al (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg. https://doi.org/10.1097/SLA.0000000000001948
doi: 10.1097/SLA.0000000000001948
pubmed: 27735827
Francis N, Penna M, Mackenzie H et al (2017) Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). Surg Endosc. https://doi.org/10.1007/s00464-017-5562-5
doi: 10.1007/s00464-017-5562-5
pubmed: 28462478
Roumen RMH, Rahusen FTG, Wijnen MHWA, Van Uchelen FAAMC (2000) “Dog ear” formation after double-stapled low anterior resection as a risk factor for anastomotic disruption. Dis Colon Rectum. https://doi.org/10.1007/BF02237198
doi: 10.1007/BF02237198
pubmed: 10789750
de Lacy FB, van Laarhoven JJEM, Pena R et al (2018) Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc. https://doi.org/10.1007/s00464-017-5944-8
doi: 10.1007/s00464-017-5944-8
pubmed: 29101570
Ma B, Gao P, Song Y et al (2016) Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer. https://doi.org/10.1186/s12885-016-2428-5
doi: 10.1186/s12885-016-2428-5
pubmed: 27899080
pmcid: 5129646
Larsen SG, Pfeffer F, Kørner H (2019) Norwegian moratorium on transanal total mesorectal excision. Br J Surg. https://doi.org/10.1002/bjs.11287
doi: 10.1002/bjs.11287
pubmed: 31802481
Roodbeen SX, Spinelli A, Bemelman WA et al (2020) Local recurrence after transanal total mesorectal excision for rectal cancer. Ann Surg. https://doi.org/10.1097/sla.0000000000003757
doi: 10.1097/sla.0000000000003757
pubmed: 32740242
Adamina M, Buchs NC, Penna M et al (2018) St. Gallen consensus on safe implementation of transanal total mesorectal excision. Surg Endosc. https://doi.org/10.1007/s00464-017-5990-2
doi: 10.1007/s00464-017-5990-2
pubmed: 30324463
pmcid: 6208708
Shrime MG, Bickler SW, Alkire BC, Mock C (2015) Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Heal. https://doi.org/10.1016/S2214-109X(14)70384-5
doi: 10.1016/S2214-109X(14)70384-5
Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc. https://doi.org/10.1007/s00464-010-0965-6
doi: 10.1007/s00464-010-0965-6
pubmed: 20820811
pmcid: 3312343
Lacy AM, Tasende MM, Delgado S et al (2015) Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2015.03.046
doi: 10.1016/j.jamcollsurg.2015.03.046
pubmed: 26206640
Veltcamp Helbach M, Koedam TWA, Knol JJ et al (2019) Residual mesorectum on postoperative magnetic resonance imaging following transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LapTME) in rectal cancer. Surg Endosc. https://doi.org/10.1007/s00464-018-6279-9
doi: 10.1007/s00464-018-6279-9
pubmed: 30888498
pmcid: 6946716
Atallah S, Albert M, Monson JRT (2016) Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery. Tech Coloproctol. https://doi.org/10.1007/s10151-016-1475-x
doi: 10.1007/s10151-016-1475-x
pubmed: 27848122
pmcid: 4920854
Fernandez-Hevia M, Delgado S, Castells A et al (2015) Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg. https://doi.org/10.1097/SLA.0000000000000865
doi: 10.1097/SLA.0000000000000865
pubmed: 25185463
Chen CC, Lai YL, Jiang JK et al (2016) Transanal total mesorectal excision versus laparoscopic surgery for rectal cancer receiving neoadjuvant chemoradiation: a matched case-control study. Ann Surg Oncol. https://doi.org/10.1245/s10434-015-4997-y
doi: 10.1245/s10434-015-4997-y
pubmed: 27921193
pmcid: 5292060
Perdawood SK, Thinggaard BS, Bjoern MX (2018) Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries. Surg Endosc. https://doi.org/10.1007/s00464-017-5926-x
doi: 10.1007/s00464-017-5926-x
pubmed: 29098433
Aubert M, Mege D, Panis Y (2019) Total mesorectal excision for low and middle rectal cancer: laparoscopic versus transanal approach—a meta-analysis. Surg Endosc. https://doi.org/10.1007/s00464-019-07160-8
doi: 10.1007/s00464-019-07160-8
pubmed: 31617090
pmcid: 7214514
Porter ME (2010) What is value in health care? N Engl J Med. https://doi.org/10.1056/NEJMp1011024
doi: 10.1056/NEJMp1011024
pubmed: 21142528