Skip to main content

Advertisement

SpringerLink
Log in

Cost-effectiveness analysis of laparoscopic versus open surgery in colon cancer

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Few economic evaluations have assessed laparoscopy for colon cancer. This study aimed to compare the cost-effectiveness of laparoscopic and open surgery for the treatment of colon cancer.

Method

A cost-effectiveness analysis was performed comparing two groups of patients treated according to standard clinical practice (REDISSEC-CARESS/CCR cohort) by laparoscopic or open surgery. Data were collected from health records on clinical characteristics and resource use over 2 years after surgery. To calculate the incremental cost-effectiveness ratio, costs and quality-adjusted life years (QALYs) were obtained for each patient. Clinical heterogeneity was addressed using propensity score and joint multivariable analysis (seemingly unrelated regression) that included interactions between TNM stage, age, and surgical procedure to perform subgroup analysis.

Results

The sample was composed of 1591 patients, 963 who underwent laparoscopy and 628 open surgery. Using propensity score and regression analysis, we found that laparoscopy was associated with more QALYs and less resource use than open surgery (0.0163 QALYs, 95% CI 0.0114–0.0212; and − €3461, 95% CI − 3337 to − 3586). Costs were lower for laparoscopy in all subgroups. In the subgroups younger than 80 years old, utility was higher in patients who underwent laparoscopy. Nevertheless, open surgery had better outcomes in older patients in stages I–II (0.0618 QALYs) and IV (0.5090 QALYs).

Conclusion

Overall, laparoscopy appears to be dominant, resulting in more QALYs and lower costs. Nevertheless, while laparoscopy required fewer resources in all subgroups, outcomes may be negatively affected in elderly patients, representing an opportunity for shared decision making between surgeons and patients.

ClinicalTrials.gov Identifier: NCT02488161

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Center MM, Jemal A, Smith RA, Ward E (2009) Worldwide variations in colorectal cancer. CA Cancer J Clin 59:366–378

    Article  Google Scholar 

  2. Gellad ZF, Provenzale D (2010) Colorectal cancer: national and international perspective on the burden of disease and public health impact. Gastroenterology 138:2177–2190

    Article  Google Scholar 

  3. Murray A, Lourenco T, de Verteuil R, Hernandez R, Fraser C, McKinley A, Krukowski Z, Vale L, Grant A (2006) Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation. Health Technol Assess 10:1–141

    Article  CAS  Google Scholar 

  4. Jensen CC, Prasad LM, Abcarian H (2012) Cost-effectiveness of laparoscopic vs open resection for colon and rectal cancer. Dis Colon Rectum 55:1017–1023

    Article  Google Scholar 

  5. Braga M, Frasson M, Zuliani W, Vignali A, Pecorelli N, Di Carlo V (2010) Randomized clinical trial of laparoscopic versus open left colonic resection. Br J Surg 97:1180–1186

    Article  CAS  Google Scholar 

  6. Schwenk W, Haase O, Neudecker J, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003145.pub2

    Article  PubMed  Google Scholar 

  7. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomized trial. Lancet Oncol 6:477–484

    Article  Google Scholar 

  8. Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192

    Article  Google Scholar 

  9. Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238:67–72

    PubMed  PubMed Central  Google Scholar 

  10. Latimer NR (2013) Survival analysis for economic evaluations alongside clinical trials–extrapolation with patient-level data: inconsistencies, limitations, and a practical guide. Med Decis Mak 33:743–754

    Article  Google Scholar 

  11. Tappenden P, Chilcott J, Ward S, Eggington S, Hind D, Hummel S (2006) Methodological issues in the economic analysis of cancer treatments. Eur J Cancer 42:2867–2875

    Article  Google Scholar 

  12. Ara R, Basarir H, Keetharuth AD, Barbieri M, Weatherly HL, Sculpher MJ, Ahmed H, Brown S (2014) Are policy decisions on surgical procedures informed by robust economic evidence? A systematic review. Int J Technol Assess Health Care 30:381–393

    Article  Google Scholar 

  13. Park JS, Kang SB, Kim SW, Cheon GN (2007) Economics and the laparoscopic surgery learning curve: comparison with open surgery for rectosigmoid cancer. World J Surg 31:1827–1834

    Article  Google Scholar 

  14. Quintana JM, Gonzalez N, Anton-Ladislao A, Redondo M, Bare M, Fernandez de Larrea N, Briones E, Escobar A, Sarasqueta C, Garcia-Gutierrez S, Aguirre U, REDISSEC-CARESS/CCR group (2016) Colorectal cancer health services research study protocol: the CCR-CARESS observational prospective cohort project. BMC Cancer 16:435

    Article  Google Scholar 

  15. Concato J, Shah N, Horwitz RI (2000) Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 342:1887–1892

    Article  CAS  Google Scholar 

  16. Benson K, Hartz AJ (2000) A comparison of observational studies and randomized, controlled trials. N Engl J Med 342:1878–1886

    Article  CAS  Google Scholar 

  17. Silverman SL (2009) From randomized controlled trials to observational studies. Am J Med 122:114–120

    Article  Google Scholar 

  18. Gatta G, Trama A, Capocaccia R (2013) Variations in cancer survival and patterns of care across Europe: roles of wealth and health-care organization. J Natl Cancer Inst Monogr 46:79–87

    Article  Google Scholar 

  19. Garrison LP, Neumann PJ, Erickson P, Marshall D, Mullins CD (2007) Using real-world data for coverage and payment decisions: the ISPOR real-world data task force report. Value in Health 10:326–335

    Article  Google Scholar 

  20. Drummond MF, Sculpher MJ, Torrance GW (2005) Methods for the economic evaluation of health care programmes. Oxford University Press, New York

    Google Scholar 

  21. Gold M, Siegel JE, Russell LB, Weinstein MC (1996) Cost-effectiveness in health and medicine. Oxford University Press, New York

    Google Scholar 

  22. Badia X, Roset M, Montserrat S, Herdman M, Segura A (1999) The Spanish version of EuroQol: a description and its applications. European Quality of Life scale. Med Clin 112(Suppl 1):79–85

    Google Scholar 

  23. Glick HA, Doshi JA, Sonnad SS, Polsky D (2014) Economic evaluation in clinical trials. Oxford University Press, New York

    Book  Google Scholar 

  24. Lanzeta I, Mar J, Arrospide A (2016) Cost-utility analysis of an integrated care model for multimorbid patients based on a clinical trial. Gac Sanit 30:352–358

    Article  Google Scholar 

  25. Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424

    Article  Google Scholar 

  26. Diamond A, Sekhon JS (2012) Genetic matching for estimating causal effects: a general multivariate matching method for achieving balance in observational studies. Rev Econ Stat 95:932–945

    Article  Google Scholar 

  27. Hardin J, Hilbe J (2012) Generalized linear models and extensions, 3rd edn. Taylor & Francis, Oxford

    Google Scholar 

  28. Willan AR, Briggs AH (2006) Statistical analysis of cost-effectiveness data. Wiley, Chichester

    Book  Google Scholar 

  29. Manca A, Hawkins N, Sculpher MJ (2005) Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ 14:487–496

    Article  Google Scholar 

  30. Lim SW, Kim YJ, Kim HR (2017) Laparoscopic surgery for colorectal cancer in patients over 80 years of age: the morbidity outcomes. Ann Surg Treat Res 92:423–428

    Article  Google Scholar 

  31. Kazama K, Aoyama T, Hayashi T, Yamada T, Numata M, Amano S, Kamiya M, Sato T, Yoshikawa T, Shiozawa M, Oshima T, Yukawa N, Rino Y, Masuda M (2017) Evaluation of short-term outcomes of laparoscopic-assisted surgery for colorectal cancer in elderly patients aged over 75 years old: a multi-institutional study (YSURG1401). BMC Surg 17:29

    Article  Google Scholar 

  32. Keller DS, Champagne BJ, Reynolds HL Jr, Stein SL, Delaney CP (2014) Cost-effectiveness of laparoscopy in rectal cancer. Dis Colon Rectum 57:564–569

    Article  Google Scholar 

  33. Govaert JA, Govaert MJ, Fiocco M, van Dijk WA, Tollenaar RA, Wouters MW, Dutch Value Based Healthcare Study Group (2016) Hospital costs of colorectal cancer surgery for the oldest old: a Dutch population-based study. J Surg Oncol 114:1009–1015

    Article  Google Scholar 

  34. Saia M, Buja A, Mantoan D, Agresta F, Baldo V (2016) Colon cancer surgery: a retrospective study based on a large administrative database. Surg Laparosc Endosc Percutan Tech 26:e126–e131

    Google Scholar 

  35. Alshreef A, Wailoo AJ, Brown SR, Tiernan JP, Watson AJM, Biggs K, Bradburn M, Hind D (2017) Cost-effectiveness of haemorrhoidal artery ligation versus rubber band ligation for the treatment of grade II-III haemorrhoids: analysis using evidence from the HubBLe trial. Pharmacoecon Open 1:175–184

    Article  Google Scholar 

  36. Bieber C, Nicolai J, Gschwendtner K, Müller N, Reuter K, Buchholz A, Kallinowski B, Härter M, Eich W (2016) How does a shared decision-making (SDM) intervention for oncologists affect participation style and preference matching in patients with breast and colon cancer? J Cancer Educ. https://doi.org/10.1007/s13187-016-1146-7

    Article  PubMed Central  Google Scholar 

  37. Snijders HS, Kunneman M, Bonsing BA, de Vries AC, Tollenaar RA, Pieterse AH, Stiggelbout AM (2014) Preoperative risk information and patient involvement in surgical treatment for rectal and sigmoid cancer. Colorectal Dis. https://doi.org/10.1111/codi.12481

    Article  PubMed  Google Scholar 

  38. Venook AP, Niedzwiecki D, Lenz HJ, Innocenti F, Fruth B, Meyerhardt JA, Schrag D, Greene C, O’Neil BH, Atkins JN, Berry S, Polite BN, O’Reilly EM, Goldberg RM, Hochster HS, Schilsky RL, Bertagnolli MM, El-Khoueiry AB, Watson P, Benson AB 3rd, Mulkerin DL, Mayer RJ, Blanke C (2017) Effect of first-line chemotherapy combined with cetuximab or bevacizumab on overall survival in patients with KRAS wild-type advanced or metastatic colorectal cancer: a randomized clinical trial. JAMA 317:2392–2401

    Article  CAS  Google Scholar 

  39. Yabroff KR, Warren JL, Schrag D, Mariotto A, Meekins A, Topor M, Brown ML (2009) Comparison of approaches for estimating incidence costs of care for colorectal cancer patients. Med Care 47:S56–63

    Google Scholar 

  40. Feinberg AE, Chesney TR, Acuna SA, Sammour T, Quereshy FA (2017) Oncologic outcomes following laparoscopic versus open resection of pT4 colon cancer: a systematic review and meta-analysis. Dis Colon Rectum 60:116–125

    Article  Google Scholar 

  41. Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Longterm results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003432.pub2

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the help of the Galdakao Hospital Accountig Departement (Susana Gárate) and Ideas Need Communicating Language Services in improving the use of English in the manuscript. The REDISSEC CARESS-CCR (Results and Health Services Research in Colorectal Cancer) group. Jose María Quintana López1, Marisa Baré Mañas2, Maximino Redondo Bautista3, Eduardo Briones Pérez de la Blanca4, Nerea Fernández de Larrea Baz5, Cristina Sarasqueta Eizaguirre6, Antonio Escobar Martínez7, Francisco Rivas Ruiz8, Maria M. Morales-Suárez-Varela9, Juan Antonio Blasco Amaro10, Isabel del Cura González11, Inmaculada Arostegui Madariaga12, Amaia Bilbao González7, Nerea González Hernández1, Susana García-Gutiérrez1, Iratxe Lafuente Guerrero1, Urko Aguirre Larracoechea1, Miren Orive Calzada1, Josune Martin Corral1, Ane Antón-Ladislao1, Núria Torà13, Marina Pont13, María Purificación Martínez del Prado14, Alberto Loizate Totorikaguena15, Ignacio Zabalza Estévez16, José Errasti Alustiza17, Antonio Z Gimeno García18, Santiago Lázaro Aramburu19, Mercè Comas Serrano20, Jose María Enríquez Navascues21, Carlos Placer Galán21, Amaia Perales22, Iñaki Urkidi Valmaña23, Jose María Erro Azkárate24, Enrique Cormenzana Lizarribar25, Adelaida Lacasta Muñoa26, Pep Piera Pibernat26, Elena Campano Cuevas27, Ana Isabel Sotelo Gómez28, Segundo Gómez-Abril29, F. Medina-Cano30, Julia Alcaide31, Arturo Del Rey-Moreno32, Manuel Jesús Alcántara33, Rafael Campo34, Alex Casalots35, Carles Pericay36, Maria José Gil37, Miquel Pera37, Pablo Collera38, Josep Alfons Espinàs39, Mercedes Martínez40, Mireia Espallargues41, Caridad Almazán42, Paula Dujovne Lindenbaum43, José María Fernández-Cebrián43, Rocío Anula Fernández44, Julio Ángel Mayol Martínez44, Ramón Cantero Cid45, Héctor Guadalajara Labajo46, María Heras Garceau46, Damián García Olmo46, Mariel Morey Montalvo47, Javier Mar 48.

1Unidad de Investigación. Hospital Galdakao-Usansolo, Galdakao-Bizkaia / Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC, 2Epidemiologia Clínica y Cribado de Cancer, Corporació Sanitaria Parc Taulí, Sabadell/Red de Investigación en Servicios de Salud en Enfermedades Crónicas – REDISSEC, 3Servicio de Laboratorio. Hospital Costa del Sol, Málaga/REDISSEC, 4Unidad de Epidemiología. Distrito Sevilla, Servicio Andaluz de Salud, 5Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid/CIBERESP, 6Unidad de Investigación. Hospital Universitario Donostia /Instituto de Investigación Sanitaria Biodonostia, Donostia – REDISSEC, 7Unidad de Investigación. Hospital Universitario Basurto, Bilbao/REDISSEC, 8Servicio de Epidemiología. Hospital Costa del Sol, Málaga – REDISSEC, 9Department of Preventive Medicine and Public Health, Univesity of Valencia/CIBER de Epidemiología y Salud Pública (CIBERESP)/CSISP-FISABIO, Valencia, 10Unidad de Evaluación de Tecnologías Sanitarias, Agencia Laín Entralgo, Madrid, 11Unidad Apoyo a Docencia-Investigación. Dirección Técnica Docencia e Investigación. Gerencia Adjunta Planificación. Gerencia de Atención Primaria de la Consejería de Sanidad de la Comunidad Autónoma de Madrid, 12Departamento de Matemática Aplicada, Estadística e Investigación Operativa, UPV- REDISSEC, 13Epidemiologia Clínica y Cribado de Cancer, Corporació Sanitaria Parc Taulí, Sabadell/REDISSEC, 14Servicio de Oncología. Hospital Universitario Basurto, Bilbao, 15Servicio de Cirugía General. Hospital Universitario Basurto, Bilbao, 16Servicio de Anatomía Patológica. Hospital Galdakao-Usansolo, Galdakao, 17Servicio de Cirugía General. Hospital Universitario Araba, Vitoria-Gasteiz, 18Servicio de Gastroenterología. Hospital Universitario de Canarias, La Laguna, 19Servicio de Cirugía General. Hospital Galdakao-Usansolo, Galdakao, 20IMAS-Hospital del Mar, Barcelona, 21Servicio de Cirugía General y Digestiva. Hospital Universitario Donostia, 22Instituto de Investigación Sanitaria Biodonostia, Donostia, 23Servicio de Cirugía General y Digestiva. Hospital de Mendaro, 24Servicio de Cirugía General y Digestiva. Hospital de Zumárraga, 25Servicio de Cirugía General y Digestiva. Hospital del Bidasoa, 26Servicio de Oncología Médica. Hospital Universitario Donostia, 27Instituto de Biomedicina de Sevilla. Hospital Universitario Virgen del Rocío, Sevilla, 28Servicio de Cirugía. Hospital Universitario Virgen de Valme, Sevilla, 29Servicio de Cirugía General y Aparato Digestivo. Hospital Dr. Peset, Valencia, 30Servicio de Cirugía General y Aparato Digestivo. Agencia Sanitaria Costa del Sol, Marbella, 31Servicio de Oncología Médica. Agencia Sanitaria Costa del Sol, Marbella, 32Servicio de Cirugía. Hospital de Antequera, 33Coloproctology Unit, General and Digestive Surgery Service, Corporació Sanitaria Parc Taulí, Sabadell, 34Digestive Diseases Department, Corporació Sanitaria Parc Taulí, Sabadell, 35Pathology Service, Corporació Sanitaria Parc Taulí, Sabadell, 36Medical Oncology Department, Corporació Sanitaria Parc Taulí, Sabadell / REDISSEC, 37General and Digestive Surgery Service, Parc de Salut Mar, Barcelona, 38General and Digestive Surgery Service, Althaia- Xarxa Assistencial Universitaria, Manresa, 39Catalonian Cancer Strategy Unit, Department of Health, Institut Català d’Oncología, 40Medical Oncology Department, Institut Català d’Oncología, 41Agency for Health Quality and Assessment of Catalonia –AquAS- and REDISSEC, 42Agency for Health Quality and Assessment of Catalonia –AQuAS-, CIBER de Epidemiología y Salud Pública –CIBERESP, 43Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Madrid, 44Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Clínico San Carlos, Madrid, 45Servicio Cirugía General y del Aparato Digestivo, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, 46Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, 47REDISSEC. Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria de la Comunidad de Madrid, Madrid, 48 REDISSEC. Unidad de Gestión Sanitaria. Hospital del Alto Deba. Mondragon-Arrasate. Spain.

Funding

This work was supported in part by Grants from the Fondo de Investigación Sanitaria (PS09/00314, PS09/00910, PS09/00746, PS09/00805, PI09/90460, PI09/90490, PI09/90397, PI09/90453, PI09/90441); Department of Health of the Basque Country (2010111098); KRONIKGUNE – Centro de Investigación en Cronicidad (KRONIK 11/006); and the European Regional Development Fund. These institutions had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the paper for publication.

Author information

Authors and Affiliations

  1. Unidad de Investigación AP-OSIs Gipuzkoa, Hospital Alto Deba, Mondragón, Spain

    Javier Mar, Oliver Ibarrondo, Arantzazu Arrospide & José M. Quintana

  2. Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain

    Ane Anton-Ladislao & Nerea Gonzalez

  3. Servicio de Cirugía General, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain

    Santiago Lázaro & Santiago Lázaro Aramburu

  4. Unidad de Epidemiología Clínica, Corporacio Parc Tauli, Barcelona, Spain

    Marisa Bare

  5. Health Technology Assessment Unit, Lain Entralgo Agency, Madrid, Spain

    Daniel Callejo

  6. Unidad de Investigación, Hospital Costa del Sol, Malaga, Spain

    Maximino Redondo

  7. Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain

    Javier Mar, Ane Anton-Ladislao, Arantzazu Arrospide, Santiago Lázaro, Nerea Gonzalez, Marisa Bare, Maximino Redondo & José M. Quintana

  8. Biodonostia Health Research Institute, Donostia-San Sebastián, Spain

    Javier Mar & Arantzazu Arrospide

  9. QuintilesIMS, Madrid, Spain

    Daniel Callejo

  10. Unidad de Gestión Sanitaria, Hospital ‘Alto Deba’, Avenida Navarra 16, 20500, Mondragón, Spain

    Javier Mar & Juan Antonio Blasco Amaro

Authors
  1. Javier Mar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ane Anton-Ladislao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Oliver Ibarrondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arantzazu Arrospide
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Santiago Lázaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nerea Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marisa Bare
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel Callejo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maximino Redondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. José M. Quintana
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the REDISSEC-CARESS/CCR group

  • Jose María Quintana López
  • , Marisa Baré Mañas
  • , Maximino Redondo Bautista
  • , Eduardo Briones Pérez de la Blanca
  • , Nerea Férnandez de Larrea Baz
  • , Cristina Sarasqueta Eizaguirre
  • , Antonio Escobar Martínez
  • , Francisco Rivas Ruiz
  • , Maria M. Morales-Suárez-Varela
  • , Juan Antonio Blasco Amaro
  • , Isabel Del Cura González
  • , Inmaculada Arostegui Madariaga
  • , Amaia Bilbao González
  • , Nerea González Hernández
  • , Susana García-Gutiérrez
  • , Iratxe Lafuente Guerrero
  • , Urko Aguirre Larracoechea
  • , Miren Orive Calzada
  • , Josune Martin Corral
  • , Ane Antón-Ladislao
  • , Núria Torà
  • , Marina Pont
  • , María Purificación Martínez del Prado
  • , Alberto Loizate Totorikaguena
  • , Ignacio Zabalza Estévez
  • , José Errasti Alustiza
  • , Antonio Z. Gimeno García
  • , Santiago Lázaro Aramburu
  • , Mercè Comas Serrano
  • , Jose María Enríquez Navascues
  • , Carlos Placer Galán
  • , Amaia Perales
  • , Iñaki Urquidi Valmaña
  • , Jose María Erro Azkárate
  • , Enrique Cormezana Lizarribar
  • , Adelaida Lacasta Muñoa
  • , Pep Peira Pibernat
  • , Elena Campano Cuevas
  • , Ana Isabel Sotelo Gómez
  • , Segundo Gómez-Abril
  • , Francisco Medina-Cano
  • , Julia Alcaide
  • , Arturo Del Rey-Moreno
  • , Manuel Jesús Alcántara
  • , Rafael Campo
  • , Alex Casalots
  • , Carles Pericay
  • , Maria José Gil
  • , Miquel Pera
  • , Pablo Collera
  • , Josep Alfons Espinàs
  • , Mercedes Martínez
  • , Mireia Espallargues
  • , Caridad Almazán
  • , Paula Dujovne Lindenbaum
  • , José María Fernández-Cebrián
  • , Rocío Anula Fernández
  • , Julio Ángel Mayol Martínez
  • , Ramón Cantero Cid
  • , Héctor Guadalajara Labajo
  • , María Heras Garceau
  • , Damián García Olmo
  • , Mariel Morey Montalvo
  •  & Javier Mar

Contributions

JMQ and JM conceived and designed the research. The REDISSEC CARESS-CCR Investigators Group acquired, analyzed, and interpreted the data. JM, AA, OI, and AA performed the statistical analyses and interpreted the data. SL, NG, MB, DC, and MR designed the research, interpreted the data, handled funding and supervision, and critically revised the manuscript. JM, JMQ, AA, OI, and AA drafted the manuscript. All authors revised the manuscript for important intellectual content and approved the final manuscript.

Corresponding author

Correspondence to Javier Mar.

Ethics declarations

Disclosures

Javier Mar MD, Ane Anton-Ladislao M.Sc, Oliver Ibarrondo PhD, Arantzazu Arrospide PhD, Santiago Lázaro MD, Nerea Gonzalez PhD, Marisa Bare MD, Daniel Callejo PhD, Maximino Redondo MD, and José M. Quintana MD have no conflicts of interest or financial ties to disclose.

Ethics approval

This project was approved by the following Ethics Committees in Spain (reference number of approval, when provided, in parentheses): the Ethics Committees of hospitals Clínico San Carlos, La Paz, Fundación Alcorcón, Txagorritxu (2009–20), Galdakao, Donostia (5/09), Basurto, and Marbella (10/09) hospitals, and the Ethics Committee of the Basque Country (PI2014084).

Informed consent

All patients were informed of the objectives of the study and invited to voluntarily participate. Patients who agreed to participate provided written consent.

Additional information

The members of the REDISSEC_CARESS/CCR group are listed in Acknowledgment section.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 26 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mar, J., Anton-Ladislao, A., Ibarrondo, O. et al. Cost-effectiveness analysis of laparoscopic versus open surgery in colon cancer. Surg Endosc 32, 4912–4922 (2018). https://doi.org/10.1007/s00464-018-6250-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6250-9

Keywords

Search

Navigation