直肠癌患者微创全直肠系膜切除术的成本概述：基于人群的经验丰富中心队列研究
A Cost Overview of Minimally Invasive Total Mesorectal Excision in Rectal Cancer Patients: A Population-based Cohort in Experienced Centres.
作者信息
Smalbroek Bo, Geitenbeek Ritchie, Burghgraef Thijs, Dijksman Lea, Hol Jeroen, Rutgers Marieke, Crolla Rogier, van Geloven Nanette, Leijtens Jeroen, Polat Fatih, Pronk Apollo, Verdaasdonk Emiel, Tuynman Jurriaan, Sietses Colin, Postma Maarten, Hompes Roel, Consten Esther, Smits Anke
机构信息
From the Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands.
出版信息
Ann Surg Open. 2023 Mar 7;4(1):e263. doi: 10.1097/AS9.0000000000000263. eCollection 2023 Mar.
BACKGROUND
Total mesorectal excision has been the gold standard for the operative management of rectal cancer. The most frequently used minimally invasive techniques for surgical resection of rectal cancer are laparoscopic, robot-assisted, and transanal total mesorectal excision. As studies comparing the costs of the techniques are lacking, this study aims to provide a cost overview.
METHOD
This retrospective cohort study included patients who underwent total mesorectal resection between 2015 and 2017 at 11 dedicated centers, which completed the learning curve of the specific technique. The primary outcome was total in-hospital costs of each technique up to 30 days after surgery including all major surgical cost drivers, while taking into account different team approaches in the transanal approach. Secondary outcomes were hospitalization and complication rates. Statistical analysis was performed using multivariable linear regression analysis.
RESULTS
In total, 949 patients were included, consisting of 446 laparoscopic (47%), 306 (32%) robot-assisted, and 197 (21%) transanal total mesorectal excisions. Total costs were significantly higher for transanal and robot-assisted techniques compared to the laparoscopic technique, with median (interquartile range) for laparoscopic, robot-assisted, and transanal at €10,556 (8,642;13,829), €12,918 (11,196;16,223), and € 13,052 (11,330;16,358), respectively ( < 0.001). Also, the one-team transanal approach showed significant higher operation time and higher costs compared to the two-team approach. Length of stay and postoperative complications did not differ between groups.
CONCLUSION
Transanal and robot-assisted approaches show higher costs during 30-day follow-up compared to laparoscopy with comparable short-term clinical outcomes. Two-team transanal approach is associated with lower total costs compared to the transanal one-team approach.
背景
全直肠系膜切除术一直是直肠癌手术治疗的金标准。直肠癌手术切除最常用的微创技术是腹腔镜手术、机器人辅助手术和经肛门全直肠系膜切除术。由于缺乏比较这些技术成本的研究，本研究旨在提供一份成本概述。
方法
这项回顾性队列研究纳入了2015年至2017年间在11个专门中心接受全直肠系膜切除术的患者，这些中心已完成特定技术的学习曲线。主要结局是术后30天内每种技术的总住院费用，包括所有主要的手术成本驱动因素，同时考虑经肛门手术中的不同团队方法。次要结局是住院时间和并发症发生率。使用多变量线性回归分析进行统计分析。
结果
总共纳入了949例患者，其中446例（47%）接受腹腔镜手术，306例（32%）接受机器人辅助手术，197例（21%）接受经肛门全直肠系膜切除术。与腹腔镜技术相比，经肛门和机器人辅助技术的总成本显著更高，腹腔镜、机器人辅助和经肛门手术的中位数（四分位间距）分别为10,556欧元（8,642；13,829）、12,918欧元（11,196；16,223）和13,052欧元（11,330；16,358）（<0.001）。此外，与双团队方法相比，单团队经肛门手术方法的手术时间明显更长，成本更高。各组之间的住院时间和术后并发症无差异。
结论
与腹腔镜手术相比，经肛门和机器人辅助手术在30天随访期间成本更高，但短期临床结局相当。与经肛门单团队方法相比，双团队经肛门方法的总成本更低。
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