title: Cost-benefit analysis of laparoscopic surgery versus laparotomy for patients with endometrioid endometrial cancer: experience from an institute in China.
abstract: OBJECTIVE
  To compare the clinical outcomes and associated costs between laparoscopic and abdominal surgery for patients with endometrioid endometrial cancer.
  
  
  METHODS
  From 2003 to 2008, 115 patients who underwent laparoscopically-assisted surgery for endometrioid endometrial cancers were enrolled in this retrospective study. Another 123 patients who had abdominal surgery for the same histological type of endometrial cancer were included as the control group. The clinico-pathological variables, surgical outcome, costs, death and case recurrence of the two groups were compared.
  
  
  RESULTS
  There was no difference in the patients' age, body mass index, FIGO stage, histological grade or surgical types between the two groups. The patients in the laparoscopy group had less blood loss (P = 0.010), a shorter hospital stay (P < 0.001), less postoperative pain (P < 0.001) and lower complication rates (P < 0.001) than those treated by laparotomy. The total costs in the laparoscopy group were higher than that in the laparotomy group ($2073 vs $1638, P < 0.001). Patients in the laparoscopy group returned to usual activity more quickly (P = 0.001) and went back to work earlier (P = 0.013) than those in laparotomy group. With a median follow-up of 42 months for the laparoscopy group and 40 months for the laparotomy group, there was no significant difference in the number of cases with respect to death (P = 1.000) or recurrence (P = 1.000).
  
  
  CONCLUSIONS
  Laparoscopically-assisted surgery is as effective as the laparotomy approach for the treatment of early-stage and advanced-stage endometrial cancer. The relatively higher cost of the laparoscopic surgery may be compensated by its benefits. In developing countries such as China, laparoscopically-assisted surgery is also an attractive alternative for selected patients with endometrial cancer.
authors.affiliation: Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 419 Fang Xie Road, Shanghai, China.
authors.forename: Zhiying
authors.initials: Z
authors.lastname: Lu
authors.forename: Xiaofang
authors.initials: X
authors.lastname: Yi
authors.forename: Weiwei
authors.initials: W
authors.lastname: Feng
authors.forename: Jingxin
authors.initials: J
authors.lastname: Ding
authors.forename: Huan
authors.initials: H
authors.lastname: Xu
authors.forename: Xianrong
authors.initials: X
authors.lastname: Zhou
authors.forename: Keqin
authors.initials: K
authors.lastname: Hua
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000191:economics / Q000473:pathology / Q000601:surgery*; D002681:China / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D016889:Endometrial Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000191:economics*; D007813:Laparotomy / Q000009:adverse effects* / Q000191:economics*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies