A comparative cost analysis of transanal and laparoscopic total mesorectal excision for rectal cancer
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ORIGINAL ARTICLE
A comparative cost analysis of transanal and laparoscopic total mesorectal excision for rectal cancer Francesca Di Candido1 · Michele Carvello1 · Deborah S. Keller2 · Elena Vanni3,4 · Annalisa Maroli1 · Isacco Montroni5 · Roel Hompes6 · Matteo Sacchi1 · Marco Montorsi7 · Antonino Spinelli1,4 Received: 25 June 2020 / Accepted: 30 August 2020 © Italian Society of Surgery (SIC) 2020
Abstract Despite proven clinical benefits in the short term, technical difficulties limit utilization of laparoscopy in rectal cancer surgery (RCS). Transanal Total Mesorectal Excision (taTME) overcomes many technical limitations of laparoscopic RCS. However, the costs of this procedure have not been addressed yet. Our goal was to perform a comparative cost analysis of taTME and laparoscopic TME (lapTME). Consecutive patients undergoing curative TME between 1 February 2014 and 31 October 2018 were selected from a prospectively maintained database and stratified, according to the type of procedure, into taTME and lapTME groups. Patient demographics, tumour characteristics, operative parameters, and short-term outcomes were analyzed. The main outcome measure was intraoperative costs of the two procedures. Secondary outcomes were shortterm outcome and the utilization of hospital resources to manage the postoperative course. Hundred and fifty-two patients with rectal cancer (66 lapTME, 86 taTME) were included in the study. Surgical supplies required for taTME procedure exceeded the cost of lapTME of 754,54 €. The duration of surgery was not significantly different between the two approaches (266 ± 92.85 vs 271 ± 83.63, p = 0.50). Short-term outcomes were comparable including postoperative complication rate (17 vs 20%, p = 0.68), reintervention rate, and length of stay. There was no difference in hospital resources utilization to manage postoperative course including blood test, diagnostics, consultations, and medications. TaTME has higher intraoperative costs in terms of supplies with respect to lapTME. Short-term outcomes and hospital resources to manage postoperative course are comparable. Keywords Rectal cancer · Total mesorectal excision (TME) · Laparoscopic total mesorectal excision (lapTME) · Transanal total mesorectal excision (taTME) · Cost analysis · Francesca Di Candido and Michele Carvello share co-first authorship.
Introduction The introduction of laparoscopy has revolutionized colorectal surgery (CRS) providing several benefits such as faster recovery, lower complication and readmission rate [1–4]. With continuous experience and evidence of improved outcomes, laparoscopy has become more cost-effective than open CRS [5, 6]. Similarly, laparoscopy has been specifically and progressively applied in rectal cancer surgery (RCS) with increased evidence on comparable costs and outcomes with respect to open approach [7–9]. However, technical difficulties related to the laparoscopic approach to the pelvis limit the ability to perform an ideal total mesorectal * Antonino Spinelli [email protected] Extended au
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