Maslekar S, Pillinger S H, Sharma A, Taylor A, Monson J R T
Academic Surgical Unit, University of Hull and Castle Hill Hospital, Hull, UK.
Colorectal Dis. 2007 Mar;9(3):229-34. doi: 10.1111/j.1463-1318.2006.01132.x.
Transanal endoscopic microsurgery (TEM) is considered to be a safe and effective treatment for selected rectal neoplasms. We demonstrate that in addition to the recognized clinical benefits of the less invasive TEM approach, there are substantial economic benefits.
We reviewed our prospective database of patients undergoing TEM excision of a rectal lesion between July 1997 and December 2003. A cost analysis was undertaken, including procedural and related costs of TEM and compared with the relevant open procedures.
124 patients (80 men, 44 women) with a median age of 71.5 years underwent TEM excision of rectal lesions (52 cancers and 72 adenomas). The morbidity rate was 8% and mortality was zero. A controlled case series of 52 patients undergoing open resection for early rectal cancers with similar characteristics as above was compared in terms of clinical outcome. The morbidity rate in these patients was 29.5%. The cost analysis comparison was undertaken using National Health Service mean reference costs for major large intestinal surgery, Intensive care unit/high dependency unit and hospital accommodation for each procedure. The average cost of open resection was 4135 pound, vs 567 pound for TEM excision. Our total saving over the series was 525,576 pound. Although the initial capital cost of the TEM equipment is high at approximately 40,000 pound given the massive cost savings, these initial equipment costs are recovered within a rapid time frame.
This study has shown that TEM is a safe and extremely cost-effective approach for excision of selected rectal tumours including rectal adenomas and early well differentiated rectal cancers (pTis & pT1).
经肛门内镜显微手术（TEM）被认为是治疗特定直肠肿瘤的一种安全有效的方法。我们证明，除了TEM这种侵入性较小的方法所公认的临床益处外，还有显著的经济效益。
我们回顾了1997年7月至2003年12月期间接受TEM切除直肠病变患者的前瞻性数据库。进行了成本分析，包括TEM的手术及相关成本，并与相关的开放手术进行比较。
124例患者（80例男性，44例女性），中位年龄71.5岁，接受了直肠病变的TEM切除（52例癌症和72例腺瘤）。发病率为8%，死亡率为零。将一组52例具有上述相似特征的早期直肠癌接受开放切除的对照病例系列在临床结果方面进行了比较。这些患者的发病率为29.5%。成本分析比较使用了英国国家医疗服务体系（National Health Service）主要大肠手术、重症监护病房/高依赖病房以及每种手术的医院住宿的平均参考成本。开放切除的平均成本为4135英镑，而TEM切除为567英镑。我们在该系列中的总节省为525,576英镑。尽管TEM设备的初始资本成本较高，约为40,000英镑，但鉴于成本大幅节省，这些初始设备成本能在短时间内收回。
本研究表明，TEM是切除特定直肠肿瘤（包括直肠腺瘤和早期高分化直肠癌（pTis和pT1））的一种安全且极具成本效益的方法。
