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

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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.

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Acknowledgements

Authors: F.D.C. and MC equally contributed in drafting the paper and analyzing the data and share first authorship for the manuscript.

Funding

The authors received no funding or support for this work.

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Author notes

  1. Francesca Di Candido and Michele Carvello share co-first authorship.

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy

    Francesca Di Candido, Michele Carvello, Annalisa Maroli, Matteo Sacchi & Antonino Spinelli

  2. Division of Colorectal Surgery, Department of Surgery, New York Presbyterian Hospital-Columbia University Medical Center, 161 Fort Washington Avenue, New York, 10032, USA

    Deborah S. Keller

  3. Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy

    Elena Vanni

  4. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, Milan, Italy

    Elena Vanni & Antonino Spinelli

  5. Division of General Surgery, Ospedale per gli Infermi, Viale Stradone 9, 48018, Faenza, Ravenna, Italy

    Isacco Montroni

  6. Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Roel Hompes

  7. Division of General and Digestive Surgery, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy

    Marco Montorsi

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  1. Francesca Di Candido
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Correspondence to Antonino Spinelli.

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Conflict of interest

RH. discloses teaching and consulting honoraria from Applied Medical and Medtronic outside of the present work A.S. has acted as speaker for Johnson and Johnson outside of the present work. M.C. has acted as speaker for Takeda and Pfizer outside of the present work. The other authors declare no other conflict of interests.

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This protocol was approved by the local Institutional Review Board (Protocol ICH857-2019).

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Di Candido, F., Carvello, M., Keller, D.S. et al. A comparative cost analysis of transanal and laparoscopic total mesorectal excision for rectal cancer. Updates Surg 73, 85–91 (2021). https://doi.org/10.1007/s13304-020-00879-3

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  • DOI: https://doi.org/10.1007/s13304-020-00879-3

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