title: A cost-minimization analysis of first intention laparoscopic compared to open right hemicolectomy for colon cancer.
abstract: BACKGROUND
  The morbidity, mortality and survival following a laparoscopic right hemicolectomy for colon cancer are equivalent to an open operation. However, the cost of a longer operating time and consumables may offset savings from a shorter length of stay (LOS). A cost minimization study was undertaken to compare the relative costs.
  
  
  METHODS
  A retrospective cohort study of consecutive elective right hemicolectomies for colon cancer performed over 5 years by two teams. One team performed an open operation (OG), the other intended to perform all operations laparoscopically (LG). Clinical outcomes and relative costs were evaluated. Results expressed as mean ± SEM.
  
  
  RESULTS
  There were 58 patients in the open group and 56 in the first intention laparoscopic group, of which 77% were completed laparoscopically. There was no difference in age, gender or cancer stage. The complications, mortality and 5-year survival were similar. Anaesthetic (LG = 63 ± 3, OG = 62 ± 2 min) and surgical times (LG = 144 ± 8, OG = 143 ± 5 min) were similar. Consumables cost €571 more and the total theatre cost was €643 ± 256 higher in the laparoscopic group compared with the open group (p = 0.01). The LOS in the laparoscopic group (4.6 ± 0.5 days) was less than in the open group (8.3 ± 1 days, p < 0.01) saving €1960 ± 636 per patient. Overall, first intention laparoscopic right hemicolectomies saved €1316 ± 733 per patient. A probability sensitivity analysis indicated a 62% probability that a laparoscopic right hemicolectomy was cheaper than an open operation.
  
  
  CONCLUSIONS
  Laparoscopic right hemicolectomy is oncologically equivalent but less costly and should be considered the procedure of choice for right-sided colon cancer unless contraindicated.
authors.affiliation: Department of Surgery, Royal Cornwall Hospital NHS Trust, England, United Kingdom.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Widdison
authors.affiliation: Department of Surgery, Royal Cornwall Hospital NHS Trust, England, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Barns
authors.affiliation: Department of Surgery, Royal Cornwall Hospital NHS Trust, England, United Kingdom.
authors.forename: Oliver
authors.initials: O
authors.lastname: Prescott
authors.affiliation: Department of Surgery, Royal Cornwall Hospital NHS Trust, England, United Kingdom.
authors.forename: Adam
authors.initials: A
authors.lastname: Pollard
keywords: Colon cancer; Cost minimisation; Minimally invasive surgery; Right hemicolectomy; Survival
references.citation: World J Gastrointest Surg. 2013 Jun 27;5(6):187-91
references.pmid: 23805362
references.citation: World J Gastroenterol. 2014 Jun 28;20(24):7926-32
references.pmid: 24976728
references.citation: Br J Surg. 2013 Jan;100(1):75-82
references.pmid: 23132548
references.citation: Int J Colorectal Dis. 2012 Jun;27(6):797-802
references.pmid: 22249439
references.citation: J Laparoendosc Adv Surg Tech A. 2013 Jan;23(1):8-16
references.pmid: 23317438
references.citation: Colorectal Dis. 2012 Aug;14(8):e447-69
references.pmid: 22540533
references.citation: Dis Colon Rectum. 2012 Oct;55(10):1017-23
references.pmid: 22965399
references.citation: Chir Ital. 2008 Jan-Feb;60(1):1-7
references.pmid: 18389741
references.citation: Health Technol Assess. 2006 Nov;10(45):1-141, iii-iv
references.pmid: 17083853
references.citation: Surg Endosc. 2007 Mar;21(3):404-8
references.pmid: 17180293
references.citation: Chir Ital. 2009 Sep-Dec;61(5-6):573-7
references.pmid: 20380260
references.citation: Surg Today. 2014 May;44(5):868-74
references.pmid: 23989942
references.citation: Colorectal Dis. 2011 Nov;13(11):1303-7
references.pmid: 20955511
references.citation: World J Gastroenterol. 2005 Jan 21;11(3):323-6
references.pmid: 15637736
references.citation: Int J Colorectal Dis. 2012 Jan;27(1):95-102
references.pmid: 21861071
references.citation: World J Surg Oncol. 2007 May 11;5:49
references.pmid: 17498289
references.citation: Clinicoecon Outcomes Res. 2014 Sep 26;6:415-22
references.pmid: 25298736
references.citation: Colorectal Dis. 2012 Sep;14(9):1118-20
references.pmid: 22181974
references.citation: Ann Surg. 2011 Dec;254(6):868-75
references.pmid: 21597360
references.citation: Surg Endosc. 2011 Nov;25(11):3597-604
references.pmid: 21656072
references.citation: Ann R Coll Surg Engl. 2011 Nov;93(8):603-7
references.pmid: 22041236
references.citation: Br J Surg. 2004 Apr;91(4):409-17
references.pmid: 15048739