A cost-minimization analysis of first intention laparoscopic compared to open right hemicolectomy for colon cancer

The morbidity, mortality and survival following a laparoscopic right hemicolectomy for colon cancer are equivalent to an open operation. However, the cost of a longer operating time and consumables may offset savings from a shorter length of stay (LOS). A cost minimization study was undertaken to compare the relative costs.

A retrospective cohort study of consecutive elective right hemicolectomies for colon cancer performed over 5 years by two teams. One team performed an open operation (OG), the other intended to perform all operations laparoscopically (LG). Clinical outcomes and relative costs were evaluated. Results expressed as mean ± SEM.

There were 58 patients in the open group and 56 in the first intention laparoscopic group, of which 77% were completed laparoscopically. There was no difference in age, gender or cancer stage. The complications, mortality and 5-year survival were similar. Anaesthetic (LG = 63 ± 3, OG = 62 ± 2 min) and surgical times (LG = 144 ± 8, OG = 143 ± 5 min) were similar. Consumables cost €571 more and the total theatre cost was €643 ± 256 higher in the laparoscopic group compared with the open group (p = 0.01). The LOS in the laparoscopic group (4.6 ± 0.5 days) was less than in the open group (8.3 ± 1 days, p < 0.01) saving €1960 ± 636 per patient. Overall, first intention laparoscopic right hemicolectomies saved €1316 ± 733 per patient. A probability sensitivity analysis indicated a 62% probability that a laparoscopic right hemicolectomy was cheaper than an open operation.

Laparoscopic right hemicolectomy is oncologically equivalent but less costly and should be considered the procedure of choice for right-sided colon cancer unless contraindicated.