Laparoscopic assisted colectomy versus laparoscopic complete colectomy: a cost analysis.

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Colon cancer management involves surgical resection, with laparoscopic techniques offering advantages over open surgery.
• Comparing different laparoscopic approaches, specifically intracorporeal vs. extracorporeal anastomosis, is crucial for optimizing patient outcomes and cost-effectiveness.
• Laparoscopic-assisted colectomy with extracorporeal anastomosis (LAC/EA) and laparoscopic complete colectomy with intracorporeal anastomosis (LCC/IA) are two such techniques.

Purpose of the Study:

• To compare short-term outcomes of LAC/EA versus LCC/IA in patients with non-metastatic resectable colon cancer.
• To explore the potential economic benefits and cost-effectiveness of each laparoscopic approach.

Main Methods:

• Retrospective analysis of patients undergoing laparoscopic hemicolectomy between January 2017 and March 2023.
• Propensity score matching (PSM) was employed to minimize selection bias and ensure comparable groups.
• Comparison of operative time, blood loss, incision length, postoperative recovery, complication rates, and costs.

Main Results:

• LCC/IA was associated with less intraoperative blood loss and shorter incision length compared to LAC/EA.
• Postoperative recovery, including time to first flatus and soft diet, was significantly shorter in the LCC/IA group.
• While surgical instrument costs were higher for LCC/IA, overall costs and 30-day postoperative complication rates were similar between the two groups.

Conclusions:

• Laparoscopic complete colectomy with intracorporeal anastomosis (LCC/IA) demonstrates superior short-term outcomes regarding blood loss and functional recovery.
• LCC/IA is a feasible, safe, and cost-effective surgical treatment option for non-metastatic resectable colon cancer.
• The findings support the wider adoption of LCC/IA for selected colon cancer patients.