Matthée Eric, Ubels Sander, Klarenbeek Bastiaan, Verstegen Moniek H P, Hannink Gerjon, van Workum Frans, Rosman Camiel, Grutters Janneke P C
Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
BJS Open. 2025 May 7;9(3). doi: 10.1093/bjsopen/zraf061.
There is a worldwide trend towards minimally invasive oesophagectomy with intrathoracic anastomosis in oesophageal cancer surgery. Minimally invasive oesophagectomy with intrathoracic anastomosis has been shown to result in fewer anastomotic leaks, but cost-effectiveness is yet to be established. The aim of this study was to determine the cost-effectiveness of transthoracic minimally invasive oesophagectomy with intrathoracic anastomosis compared with cervical anastomosis.
A prospective economic evaluation was performed alongside the ICAN trial, a randomized clinical superiority trial. Patients with mid/distal oesophageal or gastro-oesophageal junction cancer were randomly assigned to transthoracic minimally invasive oesophagectomy with either intrathoracic or cervical anastomosis. Quality-adjusted life-years, mean healthcare, and societal costs were assessed for both groups at 9 and 21 months after surgery.
A total of 245 patients randomized for transthoracic minimally invasive oesophagectomy with either intrathoracic (122) or cervical (123) anastomosis were included in the cost-effectiveness analysis. After 9 months, the intrathoracic group yielded 0.58 (95% confidence interval (c.i.) 0.55 to 0.61) quality-adjusted life-years per patient, compared with 0.56 (0.52 to 0.58) quality-adjusted life-years for the cervical group. After 9 months, both mean healthcare costs (20 573 (95% c.i. 17 623 to 24 177) versus 28 039 (23 574 to 33 116) euros), and societal costs (24 590 (21 237 to 29 074) versus 33 383 (27 885 to 38 805) euros), per patient were lower in the intrathoracic anastomosis group. Similarly, at 21 months no statistically significant difference was found (mean difference 0.08 (-0.05 to 0.2) quality-adjusted life-years), whereas minimally invasive oesophagectomy with intrathoracic anastomosis was less costly than that with cervical anastomosis (mean difference -9930 (-16 301 to -2521) euros). The higher costs in the cervical anastomosis group were mainly due to longer lengths of stay owing to complications.
Transthoracic minimally invasive oesophagectomy with intrathoracic anastomosis was found to be cost-effective compared with transthoracic minimally invasive oesophagectomy with cervical anastomosis.
在食管癌手术中，全球范围内存在着向采用胸内吻合的微创食管切除术发展的趋势。已证明采用胸内吻合的微创食管切除术可减少吻合口漏，但成本效益尚未确定。本研究的目的是确定与颈部吻合相比，采用胸内吻合的经胸微创食管切除术的成本效益。
在ICAN试验（一项随机临床优势试验）的同时进行了一项前瞻性经济评估。将中/远端食管癌或胃食管交界癌患者随机分配接受采用胸内或颈部吻合的经胸微创食管切除术。在术后9个月和21个月评估两组的质量调整生命年、平均医疗保健费用和社会成本。
共有245例随机接受采用胸内（122例）或颈部（123例）吻合的经胸微创食管切除术的患者纳入成本效益分析。9个月后，胸内吻合组每位患者的质量调整生命年为0.58（95%置信区间（c.i.）0.55至0.61），而颈部吻合组为0.56（0.52至0.58）。9个月后，胸内吻合组每位患者的平均医疗保健费用（20573（95%c.i.17623至24177）欧元对28039（23574至33116）欧元）和社会成本（245... （此处原文似乎不完整）
与采用颈部吻合的经胸微创食管切除术相比，发现采用胸内吻合的经胸微创食管切除术具有成本效益。
