Department of Colorectal Surgery, Singapore General Hospital, Outram Road, 169608, Singapore.
Group Finance Analytics, Singapore Health Services, Singapore, Singapore.
Tech Coloproctol. 2024 Jun 8;28(1):66. doi: 10.1007/s10151-024-02944-0.
We aimed to compare outcomes and cost effectiveness of extra-corporeal anastomosis (ECA) versus intra-corporeal anastomosis (ICA) for laparoscopic right hemicolectomy using the National Surgical Quality Improvement Programme data.
Patients who underwent elective laparoscopic right hemicolectomy for colon cancer from January 2018 to December 2022 were identified. Non-cancer diagnoses, emergency procedures or synchronous resection of other organs were excluded. Surgical characteristics, peri-operative outcomes, long-term survival and hospitalisation costs were compared. Incremental cost-effectiveness ratio (ICER) was used to evaluate cost-effectiveness.
A total of 223 patients (175 ECA, 48 ICA) were included in the analysis. Both cohorts exhibited comparable baseline patient, comorbidity, and tumour characteristics. Distribution of pathological TMN stage, tumour largest dimension, total lymph node harvest and resection margin lengths were statistically similar. ICA was associated with a longer median operative duration compared with ECA (255 min vs. 220 min, P < 0.001). There was a quicker time to gastrointestinal recovery, with a shorter median hospital stay in the ICA group (4.0 versus 5.0 days, P = 0.001). Overall complication rates were comparable. ICA was associated with a higher surgical procedure cost (£6301.57 versus £4998.52, P < 0.001), but lower costs for ward accommodation (£1679.05 versus £2420.15, P = 0.001) and treatment (£3774.55 versus £4895.14, P = 0.009), with a 4.5% reduced overall cost compared with ECA. The ICER of -£3323.58 showed ICA to be more cost effective than ECA, across a range of willingness-to-pay thresholds.
ICA in laparoscopic right hemicolectomy is associated with quicker post-operative recovery and may be more cost effective compared with ECA, despite increased operative costs.
本研究旨在利用国家外科质量改进计划（National Surgical Quality Improvement Programme，NSQIP）的数据，比较腹腔镜右半结肠切除术中外置吻合（extra-corporeal anastomosis，ECA）与内置吻合（intra-corporeal anastomosis，ICA）的结局和成本效果。
纳入 2018 年 1 月至 2022 年 12 月期间接受择期腹腔镜右半结肠切除术治疗结肠癌的患者。排除非癌症诊断、急诊手术或同期切除其他器官的患者。比较手术特征、围手术期结局、长期生存和住院费用。采用增量成本效果比（incremental cost-effectiveness ratio，ICER）评估成本效果。
共纳入 223 例患者（175 例行 ECA，48 例行 ICA）。两组患者的基线患者、合并症和肿瘤特征均具有可比性。肿瘤病理 T、M、N 分期、肿瘤最大直径、总淋巴结清扫和切缘长度的分布在统计学上无显著差异。与 ECA 相比，ICA 的中位手术时间更长（255 分钟比 220 分钟，P<0.001）。ICA 组的胃肠功能恢复更快，中位住院时间更短（4.0 天比 5.0 天，P=0.001）。总体并发症发生率无显著差异。ICA 手术费用较高（6301.57 英镑比 4998.52 英镑，P<0.001），但病房住宿费用（1679.05 英镑比 2420.15 英镑，P=0.001）和治疗费用（3774.55 英镑比 4895.14 英镑，P=0.009）较低，与 ECA 相比，总体费用降低了 4.5%。ICER 为-3323.58 英镑，表明与 ECA 相比，ICA 更具成本效果，在一系列支付意愿阈值范围内。
与 ECA 相比，腹腔镜右半结肠切除术中的 ICA 术后恢复更快，可能更具成本效果，尽管手术费用增加。
