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Comparative Study
. 2024 Oct;76(6):2151-2162.
doi: 10.1007/s13304-024-01876-6. Epub 2024 May 17.

Laparoscopic assisted colectomy versus laparoscopic complete colectomy: a cost analysis

Zhaoyang Zheng #  1 , Qiang Du #  1 , Libin Huang  2   3 , Lie Yang  4   5 , Zongguang Zhou  1   6
Affiliations
Comparative Study

Laparoscopic assisted colectomy versus laparoscopic complete colectomy: a cost analysis

Zhaoyang Zheng et al. Updates Surg. 2024 Oct.

Abstract

To compare the short-term outcomes and explore the potential economic benefits of laparoscopic-assisted colectomy with extracorporeal anastomosis (LAC/EA) vs. laparoscopic complete colectomy with intracorporeal anastomosis (LCC/IA) for patients with non-metastatic resectable colon cancer. Data of patients who underwent laparoscopic hemicolectomy from January 2017 to March 2023 were collected and analyzed. Propensity score matching (PSM) analyses was carried out to minimize the selection bias. Before PSM, a total of 113 patients met the inclusion criteria (39 in the LCC/IA vs. 74 in the LAC/EA). Clinicopathologic characteristics were comparable except for the median number of removed lymph nodes (P = 0.023). LCC/IA was associated with longer operative time, less intraoperative blood loss, and shorter incision length. The rate of 30-day postoperative complications was similar, but the time to first flatus and soft diet was shorter in the LCC/IA. No deaths were reported in either group within 30 days after surgery. Costs of surgical instruments (25,945.8 ± 1,918.0 vs. 23,551.9 ± 2,665.5 RMB; P < 0.01) were higher for the LCC/IA but overall costs were similar (LCC/IA, 43,220.0 ± 4,954.0 vs. LAC/EA, 41,269.2 ± 6,685.9 RMB; P = 0.112). After PSM, 38 patients in the LCC/IA and 63 patients in the LAC/EA were compared. LCC/IA was superior in terms of intraoperative blood loss, incision length, and postoperative functional recovery. There was an extra charge of 2385.0 RMB regarding surgical instruments in the LCC/IA but the overall cost did not reach statistical significance. LCC/IA is a feasible, safe, and cost-effective surgical treatment for patients with non-metastatic resectable colon cancer.

Keywords: Colon cancer; Cost analysis; Intracorporeal anastomosis; Propensity score matching.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Patient selection flow
Fig. 2
Fig. 2
Distribution of trocars of laparoscopic complete colectomy. a Laparoscopic complete right hemicolectomy. b Laparoscopic complete left hemicolectomy
Fig. 3
Fig. 3
Process of UEEA approach*. a The bowels are tied together into a U-shape by a ligature. b Anastomosis is fashioned using a linear stapler. c The common opening is tightened with a suture. d Bowel transection and stump closure using the stapler. e The stump is reinforced by barbed wire. *These figures are quoted from [43] and we have obtained permission from the copyright owners
See this image and copyright information in PMC

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