Maurer Max M, Knitter Sebastian, Winter Axel, Saidy Ramin Raul Ossami, Dobrindt Eva M, Seika Philippa, Ritschl Paul V, Raakow Jonas, Reinus Judith, Pratschke Johann, Denecke Christian
Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Charitéplatz 1, 10117, Berlin, Germany.
Langenbecks Arch Surg. 2025 Jan 8;410(1):30. doi: 10.1007/s00423-024-03562-y.
Despite ongoing discussions concerning clinical equivalence of laparoscopic total gastrectomy (LTG) compared to open total gastrectomy (OTG) in gastric cancer (GC) surgery, complementary evidence regarding financial implications is sparse. The aim of this study was to compare hospital associated expenses and perioperative outcomes between both approaches.
Clinicopathological and financial data from 80 consecutive GC patients undergoing LTG or OTG between 2015 and 2022 were investigated. Patient baseline characteristics, perioperative results, long-term outcomes and financial expenses up to 30 days after discharge were compared. A binary logistic regression model to identify individual cost drivers was performed.
LTG was associated with significantly prolonged operating time (281 min vs. 245 min, p < 0.02). However, LTG demonstrated a trend towards lower total (18,708 € vs. 22,810 €, p = 0.11) and median daily (1,516 € vs. 1,721 €, p = 0.25) expenses, yet not reaching statistical significance. Decreased ICU costs emerged as the greatest single cost reducer in LTG (962 € vs. 2,147 €, p = 0.10). Hospital length of stay ≥ 15 days was the only independent cost driver for increased expenses (HR [95% CI] = 13,2 [3.0-58.9], p < 0.01). Ultimately, patients undergoing LTG and OTG demonstrated similar outcomes in terms of perioperative morbidity (n = 8, 13% vs. n = 3, 17%, p = 0.70), median number of resected lymph nodes (n = 32 vs. n = 33, p = 0.72), absence of 90-day mortality, and long-term survival (p = 0.47).
Although typically involving longer operating times, LTG tends to be linked with decreased hospital costs, yet not reaching statistical significance. The ongoing establishment of LTG seems not to pose additional financial burdens for surgical departments.
尽管关于腹腔镜全胃切除术（LTG）与开放全胃切除术（OTG）在胃癌（GC）手术中的临床等效性一直在讨论，但关于经济影响的补充证据却很少。本研究的目的是比较两种手术方式的医院相关费用和围手术期结果。
对2015年至2022年间连续80例接受LTG或OTG的GC患者的临床病理和财务数据进行调查。比较患者的基线特征、围手术期结果、长期结局以及出院后30天内的财务费用。进行二元逻辑回归模型以识别个体成本驱动因素。
LTG与显著延长的手术时间相关（281分钟对245分钟，p < 0.02）。然而，LTG在总费用（18,708欧元对22,810欧元，p = 0.11）和日均费用（1,516欧元对1,721欧元，p = 0.25）方面有降低的趋势，但未达到统计学意义。ICU费用的降低是LTG中最大的单一成本降低因素（962欧元对2,147欧元，p = 0.10）。住院时间≥15天是费用增加的唯一独立成本驱动因素（HR [95% CI] = 13.2 [3.0 - 58.9]，p < 0.01）。最终，接受LTG和OTG的患者在围手术期发病率（n = 8，13%对n = 3，17%，p = 0.70）、切除淋巴结的中位数（n = 32对n = 33，p = 0.72）、无90天死亡率和长期生存率（p = 0.47）方面表现出相似的结果。
尽管LTG通常手术时间较长，但往往与降低的医院成本相关，但未达到统计学意义。LTG的持续开展似乎不会给外科科室带来额外的经济负担。
