Tayar Daiane Oliveira, Ribeiro Ulysses, Cecconello Ivan, Magalhães Tiago M, Simões Claudia M, Auler José Otávio C
Department of Anesthesia and Critical Care, University of São Paulo, Faculty of Medicine, São Paulo, Brazil,
Department of Gastroenterology, University of São Paulo, Faculty of Medicine, São Paulo, Brazil.
Clinicoecon Outcomes Res. 2018 Sep 12;10:521-527. doi: 10.2147/CEOR.S173718. eCollection 2018.
Laparoscopic surgery for rectal cancer is associated with improved postoperative outcomes compared to open surgery; however, economic studies have yielded contradictory results. The aim of this study was to compare the clinical and economic outcomes of laparoscopic versus open surgery for patients with rectal cancer.
Propensity score matching analysis was performed in a retrospective cohort of patients who underwent elective low anterior resection for rectal cancer treatment by laparoscopic and open surgery in a single Brazilian cancer center. Matched covariates included age, gender, body mass index, pTNM stage, American Society of Anesthesiologists score, type of anesthesia, neoadjuvant chemoradiotherapy, and interval between neoadjuvant chemoradiotherapy and index surgery. The clinical and economic outcomes were evaluated. The follow-up period was within 30 days of the index procedure. The clinical outcomes were reoperation, postoperative complications, operative time, length of stay in the intensive care unit, and postoperative hospital stay. For economic outcomes, a cost analysis was used to compare the costs.
Initially, 220 patients were evaluated. After propensity score matching, 100 patients were included in the analysis (50 patients in the open surgery group and 50 patients in the laparoscopic surgery group). There were no differences in patients' baseline characteristics. Operative time was longer for laparoscopic surgery (247 minutes vs 285 minutes, =0.006). There were no significant differences in other clinical outcomes. The hospital costs were similar between the two groups (Brazilian reais 21,233.15 vs Brazilian reais 21,529.28, =0.115), although the intraoperative costs were higher for laparoscopic surgery, mainly owing to the surgical devices and the theater-related costs. The postoperative costs were lower for laparoscopic surgery, owing to lower intensive care unit, ward, and reoperation costs.
Laparoscopic surgery for rectal cancer is not costlier than open surgery from the health care provider's perspective, since the intraoperative costs were offset by lower postoperative costs. Open surgery tends to have a longer length of stay.
与开放手术相比，腹腔镜直肠癌手术的术后效果更佳；然而，经济学研究结果却相互矛盾。本研究旨在比较腹腔镜手术与开放手术治疗直肠癌患者的临床和经济效果。
在巴西一家癌症中心，对接受选择性低位前切除术治疗直肠癌的患者进行回顾性队列研究，采用倾向评分匹配分析。匹配的协变量包括年龄、性别、体重指数、pTNM分期、美国麻醉医师协会评分、麻醉类型、新辅助放化疗以及新辅助放化疗与初次手术之间的间隔时间。评估临床和经济效果。随访期为初次手术的30天内。临床效果包括再次手术、术后并发症、手术时间、重症监护病房住院时间和术后住院时间。对于经济效果，采用成本分析比较成本。
最初评估了220例患者。经过倾向评分匹配后，100例患者纳入分析（开放手术组50例，腹腔镜手术组50例）。患者的基线特征无差异。腹腔镜手术的手术时间更长（247分钟对285分钟，P=0.006）。其他临床效果无显著差异。两组的住院费用相似（21,233.15巴西雷亚尔对21,529.28巴西雷亚尔，P=0.115），尽管腹腔镜手术的术中费用更高，主要是由于手术器械和手术室相关费用。腹腔镜手术的术后费用较低，因为重症监护病房、病房和再次手术费用较低。
从医疗服务提供者的角度来看，腹腔镜直肠癌手术并不比开放手术成本更高，因为术中成本被较低的术后成本所抵消。开放手术的住院时间往往更长。
