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Cost-effectiveness of Laparoscopy in Rectal Cancer

Keller, Deborah S. M.S., M.D.; Champagne, Bradley J. M.D.; Reynolds, Harry L. Jr. M.D.; Stein, Sharon L. M.D.; Delaney, Conor P. M.D., M.Ch., Ph.D., F.R.C.S.I.

Diseases of the Colon & Rectum: May 2014 - Volume 57 - Issue 5 - p 564–569
doi: 10.1097/DCR.0b013e3182a73244
Original Contributions: Colorectal/Anal Neoplasia

BACKGROUND: There is an increasing trend to use laparoscopy for rectal cancer surgery. Although laparoscopic and open rectal resections appear oncologically equivalent, there is little information on the cost of different surgical approaches. With the current health care crisis and the importance of optimizing health care resources and patient outcomes, the cost of care is an important factor.

OBJECTIVE: The aim of this study was to evaluate the cost-effectiveness of laparoscopy in rectal cancer.

DESIGN: This was a case-matched study.

SETTINGS: This study was conducted at a tertiary referral center.

PATIENTS: Patients undergoing elective rectal cancer resection between 2007 and 2012 were selected.

METHODS: A review of a prospective database for elective laparoscopic rectal cancer resections was performed. Laparoscopic cases were matched to open cases based on age, BMI, operative procedure, and diagnostic-related group.

MAIN OUTCOME MEASURES: The primary outcomes measured were the cost of care, hospital length of stay, discharge disposition, readmission, postoperative complications, and mortality rates.

RESULTS: Two hundred fifty-four matched cases were included in the analysis: 125 laparoscopic (49%) and 129 open (51%). The cTNM stage (p = 0.39), tumor distance from the anal verge (p = 0.07), and rate of neoadjuvant therapy received between the laparoscopic and open groups were similar (p = 0.12). Operating time (p< 0.01) and cost per operating room minute (p = 0.04) were significantly higher in the open group. The groups were oncologically equivalent, based on circumferential resection margin (p = 0.15). The laparoscopic group had a significantly shorter length of stay (p < 0.01) and lower total hospital cost (p < 0.01). Postoperative complications, 30-day readmission, reoperation, and mortality rates were similar. However, significantly more patients undergoing open resection required intensive care unit care (p = 0.03), skilled nursing (p = 0.03), or home care services (p < 0.01) at discharge.

LIMITATIONS: This investigation was conducted at a single institution and it is a retrospective study with potential bias.

CONCLUSIONS: Laparoscopy is cost-effective for rectal cancer surgery, improving both health care expenditures and patient outcomes. For selected patients, laparoscopic rectal cancer resection can reduce length of stay, operating time, and resource utilization.

Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio

Financial Disclosure: None reported.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Phoenix, AZ, April 27 to May 1, 2013.

Correspondence: Conor P. Delaney, M.D., M.Ch., Ph.D., F.R.C.S.I., Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106–5047. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons