Widdison Adam L, Barns Victoria, Prescott Oliver, Pollard Adam
Department of Surgery, Royal Cornwall Hospital NHS Trust, England, United Kingdom.
Ann Med Surg (Lond). 2015 Nov 19;5:23-8. doi: 10.1016/j.amsu.2015.11.005. eCollection 2016 Feb.
The morbidity, mortality and survival following a laparoscopic right hemicolectomy for colon cancer are equivalent to an open operation. However, the cost of a longer operating time and consumables may offset savings from a shorter length of stay (LOS). A cost minimization study was undertaken to compare the relative costs.
A retrospective cohort study of consecutive elective right hemicolectomies for colon cancer performed over 5 years by two teams. One team performed an open operation (OG), the other intended to perform all operations laparoscopically (LG). Clinical outcomes and relative costs were evaluated. Results expressed as mean ± SEM.
There were 58 patients in the open group and 56 in the first intention laparoscopic group, of which 77% were completed laparoscopically. There was no difference in age, gender or cancer stage. The complications, mortality and 5-year survival were similar. Anaesthetic (LG = 63 ± 3, OG = 62 ± 2 min) and surgical times (LG = 144 ± 8, OG = 143 ± 5 min) were similar. Consumables cost €571 more and the total theatre cost was €643 ± 256 higher in the laparoscopic group compared with the open group (p = 0.01). The LOS in the laparoscopic group (4.6 ± 0.5 days) was less than in the open group (8.3 ± 1 days, p < 0.01) saving €1960 ± 636 per patient. Overall, first intention laparoscopic right hemicolectomies saved €1316 ± 733 per patient. A probability sensitivity analysis indicated a 62% probability that a laparoscopic right hemicolectomy was cheaper than an open operation.
Laparoscopic right hemicolectomy is oncologically equivalent but less costly and should be considered the procedure of choice for right-sided colon cancer unless contraindicated.
腹腔镜右半结肠切除术治疗结肠癌后的发病率、死亡率和生存率与开放手术相当。然而，较长的手术时间和耗材成本可能会抵消较短住院时间所节省的费用。因此进行了一项成本最小化研究，以比较两者的相对成本。
对两个团队在5年内连续进行的择期结肠癌右半结肠切除术进行回顾性队列研究。一个团队进行开放手术（OG），另一个团队计划全部进行腹腔镜手术（LG）。评估临床结果和相对成本。结果以平均值±标准误表示。
开放组有58例患者，初次腹腔镜组有56例患者，其中77%的手术通过腹腔镜完成。两组患者在年龄、性别或癌症分期方面无差异。并发症、死亡率和5年生存率相似。麻醉时间（LG = 63±3分钟，OG = 62±2分钟）和手术时间（LG = 144±8分钟，OG = 143±5分钟）相似。与开放组相比，腹腔镜组的耗材成本高出571欧元，手术室总成本高出643±256欧元（p = 0.01）。腹腔镜组的住院时间（4.6±0.5天）短于开放组（8.3±1天，p < 0.01），每位患者节省1960±636欧元。总体而言，初次腹腔镜右半结肠切除术每位患者节省1316±733欧元。概率敏感性分析表明，腹腔镜右半结肠切除术比开放手术便宜的概率为62%。
腹腔镜右半结肠切除术在肿瘤学上等效，但成本更低，除非有禁忌证，应被视为右侧结肠癌的首选手术方式。
