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01-02-2021 | Rectal Cancer | Original Article

A comparative cost analysis of transanal and laparoscopic total mesorectal excision for rectal cancer

Authors: Francesca Di Candido, Michele Carvello, Deborah S. Keller, Elena Vanni, Annalisa Maroli, Isacco Montroni, Roel Hompes, Matteo Sacchi, Marco Montorsi, Antonino Spinelli

Published in: Updates in Surgery | Issue 1/2021

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 short-term 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.

Nelson H, Sargent DJ, Wieand HS et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. https://doi.org/10.1056/NEJMoa032651CrossRefPubMed

Lacy AM, García-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. https://doi.org/10.1016/S0140-6736(02)09290-5CrossRefPubMed

Heikkinen T, Msika S, Desvignes G et al (2005) Laparoscopic surgery versus open surgery for colon cancer: Short-term outcomes of a randomised trial. Lancet Oncol. https://doi.org/10.1016/S1470-2045(05)70221-7CrossRef

Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J Clin Oncol. https://doi.org/10.1200/JCO.2006.09.7758CrossRefPubMed

Keller DS, Delaney CP, Hashemi L, Haas EM (2016) A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery. Surg Endosc. https://doi.org/10.1007/s00464-015-4732-6CrossRefPubMed

Dowson HM, Huang A, Soon Y et al (2007) Systematic review of the costs of laparoscopic colorectal surgery. Dis Colon Rectum. https://doi.org/10.1007/s10350-007-0234-5CrossRefPubMed

Jeong SY, Park JW, Nam BH et al (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. https://doi.org/10.1016/S1470-2045(14)70205-0CrossRefPubMed

Bonjer HJ, Deijen CL, Abis GA et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. https://doi.org/10.1056/NEJMoa1414882CrossRefPubMed

Keller DS, Qiu J, Senagore AJ (2018) Predicting opportunities to increase utilization of laparoscopy for rectal cancer. Surg Endosc. https://doi.org/10.1007/s00464-017-5844-yCrossRefPubMed

10.

Heald RJ, Santiago I, Pares O et al (2017) The perfect total mesorectal excision obviates the need for anything else in the management of most rectal cancers. Clin Colon Rectal Surg. https://doi.org/10.1055/s-0037-1606109CrossRefPubMedPubMedCentral

11.

Quirke P, Steele R, Monson J et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. https://doi.org/10.1016/S0140-6736(09)60485-2CrossRefPubMedPubMedCentral

12.

Nagtegaal ID, Van de Velde CJH, Van Der Worp E et al (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. https://doi.org/10.1200/JCO.2002.07.010CrossRefPubMed

13.

Bondeven P, Hagemann-Madsen RH, Laurberg S, Pedersen BG (2013) Extent and completeness of mesorectal excision evaluated by postoperative magnetic resonance imaging. Br J Surg. https://doi.org/10.1002/bjs.9225CrossRefPubMed

14.

Emile SH, de Lacy FB, Keller DS et al (2018) Evolution of transanal total mesorectal excision for rectal cancer: From top to bottom. World J Gastrointest Surg. https://doi.org/10.4240/wjgs.v10.i3.28CrossRefPubMedPubMedCentral

15.

Penna M, Hompes R, Arnold S et al (2017) Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg. https://doi.org/10.1097/SLA.0000000000001948CrossRefPubMed

16.

Francis N, Penna M, Mackenzie H et al (2017) Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). Surg Endosc. https://doi.org/10.1007/s00464-017-5562-5CrossRefPubMed

17.

Roumen RMH, Rahusen FTG, Wijnen MHWA, Van Uchelen FAAMC (2000) “Dog ear” formation after double-stapled low anterior resection as a risk factor for anastomotic disruption. Dis Colon Rectum. https://doi.org/10.1007/BF02237198CrossRefPubMed

18.

de Lacy FB, van Laarhoven JJEM, Pena R et al (2018) Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc. https://doi.org/10.1007/s00464-017-5944-8CrossRefPubMed

19.

Ma B, Gao P, Song Y et al (2016) Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer. https://doi.org/10.1186/s12885-016-2428-5CrossRefPubMedPubMedCentral

20.

Larsen SG, Pfeffer F, Kørner H (2019) Norwegian moratorium on transanal total mesorectal excision. Br J Surg. https://doi.org/10.1002/bjs.11287CrossRefPubMed

21.

Roodbeen SX, Spinelli A, Bemelman WA et al (2020) Local recurrence after transanal total mesorectal excision for rectal cancer. Ann Surg. https://doi.org/10.1097/sla.0000000000003757CrossRefPubMed

22.

Adamina M, Buchs NC, Penna M et al (2018) St. Gallen consensus on safe implementation of transanal total mesorectal excision. Surg Endosc. https://doi.org/10.1007/s00464-017-5990-2CrossRefPubMedPubMedCentral

23.

Shrime MG, Bickler SW, Alkire BC, Mock C (2015) Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Heal. https://doi.org/10.1016/S2214-109X(14)70384-5CrossRef

24.

Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc. https://doi.org/10.1007/s00464-010-0965-6CrossRefPubMedPubMedCentral

25.

Lacy AM, Tasende MM, Delgado S et al (2015) Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2015.03.046CrossRefPubMed

26.

Veltcamp Helbach M, Koedam TWA, Knol JJ et al (2019) Residual mesorectum on postoperative magnetic resonance imaging following transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LapTME) in rectal cancer. Surg Endosc. https://doi.org/10.1007/s00464-018-6279-9CrossRefPubMedPubMedCentral

27.

Atallah S, Albert M, Monson JRT (2016) Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery. Tech Coloproctol. https://doi.org/10.1007/s10151-016-1475-xCrossRefPubMedPubMedCentral

28.

Fernandez-Hevia M, Delgado S, Castells A et al (2015) Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg. https://doi.org/10.1097/SLA.0000000000000865CrossRefPubMed

29.

Chen CC, Lai YL, Jiang JK et al (2016) Transanal total mesorectal excision versus laparoscopic surgery for rectal cancer receiving neoadjuvant chemoradiation: a matched case-control study. Ann Surg Oncol. https://doi.org/10.1245/s10434-015-4997-yCrossRefPubMedPubMedCentral

30.

Perdawood SK, Thinggaard BS, Bjoern MX (2018) Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries. Surg Endosc. https://doi.org/10.1007/s00464-017-5926-xCrossRefPubMed

31.

Aubert M, Mege D, Panis Y (2019) Total mesorectal excision for low and middle rectal cancer: laparoscopic versus transanal approach—a meta-analysis. Surg Endosc. https://doi.org/10.1007/s00464-019-07160-8CrossRefPubMedPubMedCentral

32.

Porter ME (2010) What is value in health care? N Engl J Med. https://doi.org/10.1056/NEJMp1011024CrossRefPubMed

Title: A comparative cost analysis of transanal and laparoscopic total mesorectal excision for rectal cancer
Authors: Francesca Di Candido
Michele Carvello
Deborah S. Keller
Elena Vanni
Annalisa Maroli
Isacco Montroni
Roel Hompes
Matteo Sacchi
Marco Montorsi
Antonino Spinelli
Publication date: 01-02-2021
Publisher: Springer International Publishing
Keywords: Rectal Cancer
Rectal Cancer
Published in: Updates in Surgery / Issue 1/2021
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-020-00879-3

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A comparative cost analysis of transanal and laparoscopic total mesorectal excision for rectal cancer

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