Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2017; 9(5): 228-234
Published online May 15, 2017. doi: 10.4251/wjgo.v9.i5.228
Introduction of laparoscopic gastrectomy for gastric cancer in a Western tertiary referral centre: A prospective cost analysis during the learning curve
Juul J Tegels, Charlotte E Silvius, Frederique E Spauwen, Karel W Hulsewé, Anton G Hoofwijk, Jan H Stoot
Juul J Tegels, Charlotte E Silvius, Frederique E Spauwen, Karel W Hulsewé, Anton G Hoofwijk, Jan H Stoot, Deptartment of Surgery, Zuyderland Medical Centre, 6162BG Sittard, The Netherlands
Author contributions: Stoot JH, Tegels JJ, Hoofwijk AG and Hulsewé KW did the study conceptualization; Tegels JJ, Spauwen FE and Silvius CE were responsible for data acquisition; Tegels JJ, Spauwen FE, Silvius CE and Stoot JH performed quality control of data and algorithms; Tegels JJ, Spauwen FE, Silvius CE, Hulsewé KW, Hoofwijk AG and Stoot JH performed data analysis interpretation; Tegels JJ performed statistical analysis; Tegels JJ, Spauwen FE and Silvius CE performed manuscript preparation; Tegels JJ was resposible for manuscript edition and first and final draft writing; Tegels JJ, Spauwen FE, Silvius CE, Hoofwijk AG, Hulsewé KW and Stoot JH performed manuscript reviews, significant writing contributions and reviewed and approved the final version of the manuscript.
Institutional review board statement: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Approval for this study was granted by the local Institutional Review Board/Ethical Standards Committee at Zuyderland Medical Centre before the start of this study. No informed consent was required for study participation as per Institutional Review Board/Ethical Standards Committee at Zuyderland Medical Centre.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Juul J Tegels, MD, Department of Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162BG Sittard, The Netherlands. ju.tegels@zuyderland.nl
Telephone: +31-88-4597777
Received: October 1, 2016
Peer-review started: October 8, 2016
First decision: January 7, 2017
Revised: January 16, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: May 15, 2017
Processing time: 222 Days and 15.5 Hours
Abstract
AIM

To evaluate the costs of the introduction of a laparoscopic surgery program for gastric cancer in a Western community training hospital and tertiary referral centre for gastric cancer surgery.

METHODS

All patients who underwent surgery for gastric cancer with curative intent in 2013 and 2014 were prospectively included. Primary outcomes were costs regarding surgery and hospital stay.

RESULTS

Laparoscopic gastrectomy was used in 52 patients [mean age 68 years (± 9, range 50 to 87)] and open gastrectomy was used in 25 patients [mean age 70 years (± 10, range 46 to 85)]. Mean costs (in euro’s) of surgical instrumentation were significantly higher for laparoscopic surgery: 2270 ± 670 vs 1181 ± 680 in the open approach (P < 0.001). Costs of theatre use were higher in the laparoscopic group: mean 3819 ± 865 vs 2545 ± 1268 in the open surgery (P < 0.001). Total costs of hospitalization (i.e., costs of surgery and admission) were not different between laparoscopic and open surgery, 8187 ± 4864 and 7673 ± 8064 respectively (P = 0.729). Mean length of hospital stay was 9 ± 12 d in the laparoscopic group vs 14 ± 14 d in the open group (P = 0.044).

CONCLUSION

The introduction of laparoscopic gastrectomy for gastric cancer coincided with higher costs for theatre use and surgical instrumentation compared to the open technique. Total costs were not significantly different due to shorter length of stay and less intensive care unit (ICU) admissions and shorter ICU stay in the laparoscopic group.

Keywords: Laparoscopic surgery; Healthcare costs; Gastric cancer

Core tip: The introduction of laparoscopic surgery for gastric cancer did not seem to result in increased costs as compared to open gastrectomy for gastric cancer. Despite higher operating room costs (longer operating time and more costly operating room materials) costs were similar between the open and laparoscopic group due to reduced length of stay and complication rate in laparoscopic gastrectomy patients.