Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer

Janson, Martin; Björholt, Ingela; Carlsson, Per; Haglind, Eva; Henriksson, Martin; Lindholm, Elisabeth; Anderberg, B

doi:10.1002/bjs.4469

Cited by 161 publications

(147 citation statements)

References 18 publications

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“…The laparoscopic procedure was more expensive in terms of theatre costs, whilst the other hospital costs such as ward, ICU and HDU and complications were higher in the patients randomised to the open procedure. The results of this trial are consistent with other costing studies of laparoscopic surgery for colorectal cancer (Philipson et al, 1997, Khalili et al, 1998, Delaney et al, 2003, Janson et al, 2004. Khalili et al (1998) found similar costs between treatment groups, though the operating theatre costs were higher for laparoscopic surgery.…”

Section: Discussionsupporting

confidence: 87%

“…The recent COLOR trial has provided a similar approach to the analysis of short-term costs undertaken in the current trial, with a sample of 210 Swedish patients from a multinational trial of 1200 patients with colon cancer (Janson et al, 2004). Societal costs were higher in the patients who underwent conventional open surgery, although as expected operative costs were higher in patients who underwent laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 86%

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Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

et al. 2006

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The short-term clinical results of the CLASICC trial indicated that clinical outcomes were similar between laparoscopic and open approaches. This study presents the short-term (3 month) cost analysis undertaken on a subset of patients entered into the CLASICC trial (682 of 794 patients). As expected the costs associated with the operation were higher in the 452 patients randomised to laparoscopic surgery (lap) compared with the 230 randomised to open procedure (open), d1703 vs d1386. This was partially offset by the other hospital (nontheatre) costs, which were lower in the lap group (d2930 vs d3176). The average cost to individuals for reoperations was higher in the lap group (d762 vs d553). Overall costs were slightly higher in the lap group (d6899 vs d6631), with mean difference of d268 (95%CI À689 to 1457). Sensitivity analysis made little difference to these results. The cost of rectal surgery was higher than for colon, for lap (d8259 vs d5586) and open procedures (d7820 vs d5503). The short-term cost analysis for the CLASICC trial indicates that the costs of either laparoscopic or open procedure were similar, lap surgery costing marginally more on average than open surgery.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 86%

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

et al. 2006

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“…The primary goal of the colon carcinoma laparoscopic or open resection (COLOR) trial was to compare 3-year cancer-free survival after laparoscopic and open resection for right colon, left colon, or sigmoid cancer, and the sample size was calculated accordingly. Laparoscopic colon resection for colonic cancer results in a smoother immediate postoperative period for the patient and improved health-related quality of life for 2-4 weeks compared with open surgery, at a higher cost for the first 3 months after surgery for hospitals but not in the societal perspective [14,18,19,23,24]. In the longer perspective, there was improved [16] or unchanged survival [17,21,22].…”

mentioning

confidence: 99%

Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial

et al. 2011

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Background Postoperative bowel obstruction caused by intra-abdominal adhesions occurs after all types of abdominal surgery. It has been suggested that the laparoscopic technique should reduce the risk for adhesion formation and thus for postoperative bowel obstruction. This study was designed to compare the incidence of bowel obstruction in a randomized trial where laparoscopic and open resection for colon cancer was compared. Methods A retrospective analysis was performed, collecting data of episodes of bowel obstruction with or without surgery. Only episodes treated in the hospital where the index surgery took place were included. Data for 786 patients were collected for the 5-year period after cancer surgery. Results Baseline characteristics for the evaluated laparoscopic (n = 383) and open (n = 403) groups were comparable. The cumulative obstruction percentages at 5 years for the open and laparoscopic groups were 6.5 and 5.1% respectively and did not significantly differ from each other. Tumor stage seemed to influence the risk for bowel obstruction: 2.8% in stage I, 6.6% in stage II, and 7% in stage III, but the differences were not significant. Conclusions This analysis does not support the hypothesis that laparoscopy leads to fewer episodes of bowel obstruction compared with open surgery.Surgical trauma is the cause of more than 90% of intraabdominal adhesions, and approximately 30% of patients who undergo major surgery develop postoperative

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“…A recent randomized study from Sweden has compared laparoscopic with open surgery for colonic cancer and concluded that within 12 weeks of surgery, there was no significant difference in total costs to society [18].…”

Section: Discussionmentioning

confidence: 99%

A Study of 101 Laparoscopic Colorectal Surgeries: a Single Surgeon Experience. How Important Is the Learning Curve?

Heroor

Panjwani

Chaskar³

2015

Indian J Surg

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This study aims to document demographic and intraoperative variables and short-term postoperative outcomes in patients being operated by laparoscopy-assisted colorectal surgeries and assessing the magnitude of impact of the learning curve on surgical results. This study included 101 patients with colonic or rectal pathology getting operated for laparoscopy-assisted colorectal surgeries carried out by the same surgeon over 5 years (2008 to 2013). The patient data was retrospectively analyzed for pre-decided variables. Also, comparison was made between the surgeries performed during the learning curve of initial 30 cases with subsequent operations. Laparoscopic colorectal surgeries give satisfactory results in terms of intraoperative parameters like surgical duration, blood loss, and clinico-pathologic parameters like lymph nodal resection and distal and circumferential margins. Patients undergoing laparoscopic colorectal surgeries fare better in short-term postoperative period while early long-term outcomes appear similar as compared to the standard open colorectal surgeries. The surgical outcomes, both intraoperative and early postoperative, improve significantly once the learning curve is negotiated. Laparoscopic Surgery can be safely used as an alternative to conventional open colorectal surgeries without compromising on oncological principles.

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Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer

Abstract: Within 12 weeks of surgery for colonic cancer, there was no difference in total costs to society incurred by LCR and OCR. The LCR procedure, however, was more costly to the healthcare system.

Cited by 161 publications

References 18 publications

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial

A Study of 101 Laparoscopic Colorectal Surgeries: a Single Surgeon Experience. How Important Is the Learning Curve?

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