Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, South Korea.
Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Asian J Surg. 2020 Apr;43(4):557-563. doi: 10.1016/j.asjsur.2019.06.012. Epub 2019 Jul 22.
BACKGROUND/OBJECTIVE: Although many studies have demonstrated similar perioperative outcomes for single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) for colon cancer, few have directly compared the costs of them. We aimed to compare costs between SILS and CLS for colon cancer.
We analyzed the clinical outcomes and overall hospital costs of patients who underwent laparoscopic surgery for colon cancer from July 2009 to September 2014 at our institution; 288 were used for analysis after propensity score matching. The total hospital charge, including fees for the operation, anesthesia, preoperative diagnosis, and postoperative management was analyzed.
The total hospital charges were similar in both groups ($8770.40 vs. $8352.80, P = 0.099). However, the patients' total hospital bill was higher in the SILS group than in the CLS group ($4184.82 vs. $3735.00, P < 0.001) mainly due to the difference of the cost of access devices. There was no difference in the additional costs associated with readmission due to late complications between the two groups ($2383.08 vs. $2288.33, P = 0.662). Incremental cost-effectiveness ratio for total incision length in 'total hospital charge' and patient's bill and government's bill in 'cost of instruments and supplies' were -$107.08/1 cm, -$109.70/1 cm, and $80.64/1 cm, respectively.
SILS for colon cancer yielded similar costs as well as perioperative and long-term outcomes compared with CLS. Therefore, SILS can be considered a reasonable treatment option for colon cancer for selective patients.
背景/目的：虽然许多研究表明单孔腹腔镜手术（SILS）与传统腹腔镜手术（CLS）治疗结肠癌的围手术期结果相似，但很少有研究直接比较它们的成本。我们旨在比较 SILS 与 CLS 治疗结肠癌的成本。
我们分析了 2009 年 7 月至 2014 年 9 月在我院接受腹腔镜结肠癌手术的患者的临床结局和总住院费用；在倾向评分匹配后，有 288 例患者用于分析。分析总住院费用，包括手术、麻醉、术前诊断和术后管理费用。
两组的总住院费用相似（8770.40 美元对 8352.80 美元，P=0.099）。然而，SILS 组患者的总住院费用高于 CLS 组（4184.82 美元对 3735.00 美元，P<0.001），主要是由于入路设备成本的差异。两组因晚期并发症再入院的额外费用无差异（2383.08 美元对 2288.33 美元，P=0.662）。“总住院费用”和“患者费用和政府费用”中“器械和耗材成本”的总切口长度增量成本效益比分别为-107.08 美元/1cm、-109.70 美元/1cm 和 80.64 美元/1cm。
与 CLS 相比，SILS 治疗结肠癌的成本以及围手术期和长期结局相似。因此，SILS 可以被认为是选择性结肠癌患者的一种合理治疗选择。
