Colonoscopic-assisted laparoscopic wedge resection versus segmental colon resection for benign colonic polyps: a comparative cost analysis.
CAL-WR
Colonoscopic-assisted laparoscopic wedge resection
colon polyps
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
revised:
15
08
2023
received:
10
05
2023
accepted:
05
09
2023
medline:
27
11
2023
pubmed:
10
10
2023
entrez:
10
10
2023
Statut:
ppublish
Résumé
The colonoscopic-assisted laparoscopic wedge resection (CAL-WR) is proven to be an effective and safe alternative to a segmental colon resection (SCR) for large or complex benign colonic polyps that are not eligible for endoscopic removal. This analysis aimed to evaluate the costs of CAL-WR and compare them to the costs of an SCR. A single-centre 90-day 'in-hospital' comparative cost analysis was performed on patients undergoing CAL-WR or SCR for complex benign polyps between 2016 and 2020. The CAL-WR group consisted of 44 patients who participated in a prospective multicentre study (LIMERIC study). Inclusion criteria were (1) endoscopically unresectable benign polyps; (2) residual or recurrence after previous polypectomy; or (3) irradically resected low risk pT1 colon carcinoma. The comparison group, which was retrospectively identified, included 32 patients who underwent an elective SCR in the same period. Colonoscopic-assisted laparoscopic wedge resection was associated with significantly fewer complications (7% in the CAL-WR group vs. 45% in the SCR group, P < 0.001), shorter operation time (50 min in the CAL-WR group vs. 119 min in the SCR group, P < 0.001), shorter length of hospital stay (median length of stay 2 days in the CAL-WR group vs. 4 days in the SCR group, P < 0.001) and less use of surgical resources (reduction in costs of 32% per patient), resulting in a cost savings of €2372 (£2099 GBP) per patient (P < 0.001). Given the clinical and financial benefits, CAL-WR should be recommended for complex benign polyps that are not eligible for endoscopic resection before major surgery is considered.
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2147-2154Subventions
Organisme : Isala Innovation and Science fund
Informations de copyright
© 2023 Association of Coloproctology of Great Britain and Ireland.
Références
Zwager LW, Bastiaansen BAJ, Bronzwaer MES, van der Spek BW, Heine GDN, Haasnoot KJC, et al. Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry. Endoscopy. 2020;52(11):1014-1023.
Puli SR, Kakugawa Y, Gotoda T, Antillon D, Saito Y, Antillon MR. Meta-analysis and systematic review of colorectal endoscopic mucosal resection. World J Gastroenterol. 2009;15(34):4273-4277.
De Ceglie A, Hassan C, Mangiavillano B, Matsuda T, Saito Y, Ridola L, et al. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: a systematic review. Crit Rev Oncol Hematol. 2016;104:138-155.
Byeon J, Yang D, Kim K, Ye BD, Myung S, Yang S, et al. Endoscopic submucosal dissection with or without snaring for colorectal neoplasms. Gastrointest Endosc. 2011;74(5):1075-1083.
Saito Y, Yamada M, So E, Abe S, Sakamoto T, Nakajima T, et al. Colorectal endoscopic submucosal dissection: technical advantages compared to endoscopic mucosal resection and minimally invasive surgery. Dig Endosc. 2014;26(Suppl 1):52-61.
Longcroft-Wheaton G, Duku M, Mead R, Basford P, Bhandari P. Risk stratification system for evaluation of complex polyps can predict outcomes of endoscopic mucosal resection. Dis Colon Rectum. 2013;56(8):960-966.
Angarita FA, Feinberg AE, Feinberg SM, Riddell RH, McCart JA. Management of complex polyps of the colon and rectum. Int J Colorectal Dis. 2018;33(2):115-129.
Hassan C, Repici A, Sharma P, Correale L, Zullo A, Bretthauer M, et al. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut. 2016;65(5):806-820.
Vermeer NCA, de Neree Tot Babberich MPM, Fockens P, Nagtegaal ID, van de Velde CJH, Dekker E, et al. Multicentre study of surgical referral and outcomes of patients with benign colorectal lesions. BJS Open. 2019;3(5):687-695.
Vermeer NCA, Backes Y, Snijders HS, Bastiaannet E, Liefers GJ, Moons LMG, et al. National cohort study on postoperative risks after surgery for submucosal invasive colorectal cancer. BJS Open. 2019;3(2):210-217.
Marres CCM, Buskens CJ, Schriever E, Verbeek PCM, Mundt MW, Bemelman WA, et al. The impact of the national bowel screening program in the Netherlands on detection and treatment of endoscopically unresectable benign polyps. Tech Coloproctol. 2017;21(11):887-891.
Breekveldt ECH, Lansdorp-Vogelaar I, Toes-Zoutendijk E, Spaander MCW, van Vuuren AJ, van Kemenade FJ, et al. Colorectal cancer incidence, mortality, tumour characteristics, and treatment before and after introduction of the faecal immunochemical testing-based screening programme in the Netherlands: a population-based study. Lancet Gastroenterol Hepatol. 2022 Jan;7(1):60-68.
Bosch D, Leicher LW, Vermeer NCA, Peeters CMJ, de Vos tot Nederveen Cappel WH, van Westreenen HL. Referrals for surgical removal of polyps since the introduction of a colorectal cancer screening programme. Colorectal Dis. 2021;23(3):672-679.
MaG E, Toes-Zoutendijk E, Vink GR, Lansdorp-Vogelaar I, Meijer GA, Dekker E, et al. National population screening for colorectal carcinoma in the Netherlands: results of the first years since the implementation in 2014. Ned Tijdschr Geneeskd. 2018;162:D2283.
Noren ER, Wickham C, Lee SW. Current techniques for combined endoscopic and laparoscopic surgery (CELS). Annal Laparoscop Endoscop Surg. 2019;4:77.
Golda T, Lazzara C, Sorribas M, Soriano A, Frago R, Alrasheed A, et al. Combined endoscopic-laparoscopic surgery (CELS) can avoid segmental colectomy in endoscopically unremovable colonic polyps: a cohort study over 10 years. Surg Endosc. 2022;36(1):196-205.
Marres CCM, Smit MPCM, van der Bilt JDW, Buskens CJ, Mundt MW, Verbeek PCM, et al. Laparoscopic wedge resection as an alternative to laparoscopic oncological colon resection for benign endoscopically unresectable colon polyps. Colorectal Dis. 2021;23(9):2361-2367.
Leicher LW, Huisman JF, van Grevenstein WMU, Didden P, Backes Y, Offerhaus GJA, et al. Colonoscopic-assisted laparoscopic wedge resection for colonic lesions: a prospective multicenter cohort study (LIMERIC-study). Ann Surg. 2022;275(5):933-939.
Leicher LW, de Vos tot Nederveen Cappel WH, van Westreenen HL. Limited endoscopic-assisted wedge resection for excision of colon polyps. Dis Colon Rectum. 2017;60(3):299-302.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213.
Govaert JA, Fiocco M, van Dijk WA, Kolfschoten NE, Prins HA, Dekker JT, et al. Multicenter stratified comparison of hospital costs between laparoscopic and open colorectal cancer resections: influence of tumor location and operative risk. Ann Surg. 2017;266(6):1021-1028.
den Ambtman A, Knoben J, van den Hurk D, Van Houdenhoven M. Analysing actual prices of medical products: a cross-sectional survey of Dutch hospitals. BMJ Open. 2020;10(2):e035174.
Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status-historical perspectives and modern developments. Anaesthesia. 2019;74(3):373-379.
Richtlijn voor het uitvoeren van economische evaluaties in de gezondheidszorg | Publicatie | Zorginstituut Nederland. Zorginstituut Nederland 2021.
Kaplan RS, Anderson SR. Time-driven activity-based costing. Harv Bus Rev. 2004;82(11):131-150.
Potter S, Davies C, Davies G, Rice C, Hollingworth W. The use of micro-costing in economic analyses of surgical interventions: a systematic review. Health Econom Rev. 2020;10(1):3.
Ismail I, Wolff S, Gronfier A, Mutter D, Swanström LL. A cost evaluation methodology for surgical technologies. Surg Endosc. 2015;29(8):2423-2432.
Hanevelt J, Moons LMG, Hentzen JEKR, Wemeijer TM, Huisman JF, de Vos tot Nederveen Cappel WH, et al. Colonoscopy-assisted laparoscopic wedge resection for the treatment of suspected T1 colon cancer. Ann Surg Oncol. 2023;30(4):2058-2065.
Zwager LW, Mueller J, Stritzke B, Montazeri NSM, Caca K, Dekker E, et al. Adverse events of endoscopic full-thickness resection: results from the German and Dutch nationwide colorectal FTRD registry. Gastrointest Endosc. 2023;97(4):780-789.e4.
Kim ER, Chang DK. Management of complications of colorectal submucosal dissection. Clin Endosc. 2019;52(2):114-119.
Akintoye E, Kumar N, Aihara H, Nas H, Thompson CC. Colorectal endoscopic submucosal dissection: a systematic review and meta-analysis. Endosc Int Open. 2016;4(10):E1030-E1044.
van der Linden YTK, Govaert JA, Fiocco M, van Dijk WA, Lips DJ, Prins HA. Single center cost analysis of single-port and conventional laparoscopic surgical treatment in colorectal malignant diseases. Int J Colorectal Dis. 2017;32(2):233-239.
Gillissen F, Hoff C, Maessen JMC, Winkens B, Teeuwen JHFA, von Meyenfeldt MF, et al. Structured synchronous implementation of an enhanced recovery program in elective colonic surgery in 33 hospitals in the Netherlands. World J Surg. 2013;37(5):1082-1093.
La Regina D, Di Giuseppe M, Lucchelli M, Saporito A, Boni L, Efthymiou C, et al. Financial impact of anastomotic leakage in colorectal surgery. J Gastrointest Surg. 2019;23(3):580-586.