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. 2023 Mar 29;38(1):86.
doi: 10.1007/s00384-023-04361-5.

Cost-effectiveness comparison of minimally invasive, robotic and open approaches in colorectal surgery: a systematic review and bayesian network meta-analysis of randomized clinical trials

Aik Yong Chok  1 , Yun Zhao  1   2 , Ivan En-Howe Tan  2 , Marianne Kit Har Au  2 , Emile John Kwong Wei Tan  3
Affiliations

Cost-effectiveness comparison of minimally invasive, robotic and open approaches in colorectal surgery: a systematic review and bayesian network meta-analysis of randomized clinical trials

Aik Yong Chok et al. Int J Colorectal Dis. .

Abstract

Purpose: This study compares the cost-effectiveness of open, laparoscopic (LAP), laparoscopic-assisted (LAPA), hand-assisted laparoscopic (HAL), and robotic colorectal surgery using a network meta-analysis.

Methods: Randomized clinical trials (RCTs) evaluating the cost-effectiveness of comparing the five different approaches in colorectal surgery were included in a literature search until September 2022. Bayesian network meta-analysis was conducted, and surface under cumulative ranking area (SUCRA) values, odds ratio (OR), and 95% credible intervals (CrIs) were reported for total costs, surgical costs, operating time, length of stay (LOS), and postoperative outcomes. Cluster analysis was performed to examine the similarity and classification of surgical approaches into homogeneous clusters. The cophenetic correlation coefficient (cc) was evaluated to identify the most cost-effective clustering method. The primary outcomes assessed were: costs-morbidity, costs-mortality, and costs-efficacy, measuring total costs against postoperative complications, mortality rate, and LOS, respectively.

Results: 22 RCTs with 4239 patients were included. Open surgery had the lowest total costs, surgical costs, and operating time but the longest LOS and most postoperative complications. LOS was significantly decreased in LAP compared to open surgery (OR 0.67, 95% CrI 0.46-0.96). Robotic surgery resulted in the highest total costs, surgical costs, and most extended operative duration but the shortest LOS and lowest mortality. LAPA and robotic surgery were superior in the costs-morbidity analysis. HAL was associated with the worst costs-mortality profile. LAP, LAPA, and HAL were better in terms of costs-efficacy.

Conclusion: Overall, LAP and LAPA are the most cost-effective approaches for colorectal surgery in terms of overall postoperative complications, mortality, and LOS.

Keywords: Colorectal surgery; Cost-effectiveness; Laparoscopic; Minimally invasive surgery; Network meta-analysis; Robotic.

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References

    1. Sajid MS, Rathore MA, Baig MK et al (2017) A critical appraisal of the cost effectiveness of laparoscopic colorectal surgery for oncological and non-oncological resections. Updates Surg 69:339–344 - PubMed
    1. Lacy AM, García-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. The Lancet 359:2224–2229
    1. Nelson H, Sargent D, Fleshman J (2004) Clinical outcomes of surgical therapy study group of the laparoscopic colectomy trial. A comparison of laparoscopically assisted and open colectomy for colon cancer. New Engl J Med 350:2050–2059 - PubMed
    1. Senagore AJ, Delaney CP, Brady KM et al (2004) Standardized approach to laparoscopic right colectomy: outcomes in 70 consecutive cases. J Am College Surgeons 199:675–679
    1. Veldkamp R (2005) COlon cancer Laparoscopic or Open Resection Study Group (COLOR): Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484 - PubMed

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