Comparison of the cost and outcomes following totally laparoscopic and laparoscopy-assisted distal gastrectomies for gastric cancer: a single-institution comparison
Objective This study aimed to compare the short-term surgical outcomes and cost–benefits following totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for the treatment of gastric cancer. Methods Between April 2007 and December 2013, a total of 100 patie...
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| Veröffentlicht in: | Surgical endoscopy 2016-08, Vol.30 (8), p.3573-3581 |
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| creator | Shinohara, Toshihiko Kawano, Susumu Tanaka, Yujiro Fujisaki, Muneharu Watanabe, Atsushi Yamamoto, Katsuhiro Hanyu, Nobuyoshi |
| description | Objective
This study aimed to compare the short-term surgical outcomes and cost–benefits following totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for the treatment of gastric cancer.
Methods
Between April 2007 and December 2013, a total of 100 patients with gastric cancer underwent laparoscopic distal gastrectomy. The patients were classified into two groups according to whether intracorporeal anastomosis or extracorporeal anastomosis had been performed. The comparison between the groups was based on clinicopathological characteristics and surgical and economic outcomes.
Results
There were 57 and 43 patients who underwent TLDG and LADG, respectively. The patients’ demographics and tumor characteristics did not show any statistically significant differences with the exception for tumor location. In the LADG group, tumors were localized to relatively higher positions (
p
= 0.024) and received Roux-en-Y reconstruction more frequently (
p
|
| doi_str_mv | 10.1007/s00464-015-4656-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1806437083</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1806437083</sourcerecordid><originalsourceid>FETCH-LOGICAL-c398t-d4ed7883119ef360c915cd2ad0d8849f41d3d5db5dcc13921c016d6fea093e1d3</originalsourceid><addsrcrecordid>eNp1kc9u1DAQxi0EotvCA3BBlrhwcfHEjpNwQyv6R6rEBc6WazuLKydePI7Qvk8fFG9TCkLiNNLM7_s8no-QN8DPgfPuA3IulWQcWiZVqxg8IxuQomFNA_1zsuGD4KzpBnlCThHveMUHaF-Sk0a1EjqhNuR-m6a9yQHTTNNIy3dPbcJCzexoWopNk0c6phjTzzDvaEnFxHig0VRRQpv2wT6wfxoHZhADFu-oq8VEujNYsrclTeHBLK-dqrRmtj5_pIZidY-ehRlLKEsJdR37tNkr8mI0Ef3rx3pGvl18_rq9YjdfLq-3n26YFUNfmJPedX0vAAY_CsVt_ax1jXHc9b0cRglOuNbdts5aEEMDloNyavSmHsrX4Rl5v_ruc_qxeCx6Cmh9jGb2aUENPVdSdLwXFX33D3qXljzX7SoFAEIMA1QKVsrW22D2o97nMJl80MD1MUK9RqhrhPoYoT5q3j46L7eTd0-K35lVoFkBrKN55_NfT__X9RcaeKs7</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1811133991</pqid></control><display><type>article</type><title>Comparison of the cost and outcomes following totally laparoscopic and laparoscopy-assisted distal gastrectomies for gastric cancer: a single-institution comparison</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Shinohara, Toshihiko ; Kawano, Susumu ; Tanaka, Yujiro ; Fujisaki, Muneharu ; Watanabe, Atsushi ; Yamamoto, Katsuhiro ; Hanyu, Nobuyoshi</creator><creatorcontrib>Shinohara, Toshihiko ; Kawano, Susumu ; Tanaka, Yujiro ; Fujisaki, Muneharu ; Watanabe, Atsushi ; Yamamoto, Katsuhiro ; Hanyu, Nobuyoshi</creatorcontrib><description>Objective
This study aimed to compare the short-term surgical outcomes and cost–benefits following totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for the treatment of gastric cancer.
Methods
Between April 2007 and December 2013, a total of 100 patients with gastric cancer underwent laparoscopic distal gastrectomy. The patients were classified into two groups according to whether intracorporeal anastomosis or extracorporeal anastomosis had been performed. The comparison between the groups was based on clinicopathological characteristics and surgical and economic outcomes.
Results
There were 57 and 43 patients who underwent TLDG and LADG, respectively. The patients’ demographics and tumor characteristics did not show any statistically significant differences with the exception for tumor location. In the LADG group, tumors were localized to relatively higher positions (
p
= 0.024) and received Roux-en-Y reconstruction more frequently (
p
< 0.001). There were no differences in the incidence of morbidity. Anastomotic leakage was not recorded in either group, although anastomotic stenosis occurred in one patient (1.8 %) after TLDG and in two patients (4.7 %) after LADG. Compared with the LADG group, the TLDG group was associated with significantly less operative blood loss (
p
< 0.001), a shorter time to oral intake (
p
= 0.012), and hospital stay (
p
= 0.018). The median operation costs were greater in the TLDG group than in the LADG group (¥982,000 in TLDG vs. ¥879,830 in LADG;
p
< 0.001), whereas the median total hospital costs were similar between the two groups (¥1302,665 in LADG vs. ¥1383,322 in TLDG:
p
= 0.119).
Conclusion
This study suggests that TLDG is as technically feasible, safe, and effective as LADG for treating patients with gastric cancer. Furthermore, TLDG is associated with equivalent total hospital costs compared with LADG. The increased operation cost is offset by the decreased costs associated with longer periods of hospitalization.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-015-4656-1</identifier><identifier>PMID: 26541736</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical ; Cancer therapies ; Endoscopy ; Female ; Gastrectomy - economics ; Gastrectomy - methods ; Gastric cancer ; Gastroenterology ; Gastrointestinal surgery ; Gynecology ; Hepatology ; Hospital Costs ; Hospitalization ; Humans ; Japan ; Laparoscopy ; Laparoscopy - economics ; Laparotomy ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Patients ; Proctology ; Retrospective Studies ; Stomach Neoplasms - surgery ; Surgeons ; Surgery ; Surgical anastomosis ; Surgical outcomes ; Tumors</subject><ispartof>Surgical endoscopy, 2016-08, Vol.30 (8), p.3573-3581</ispartof><rights>Springer Science+Business Media New York 2015</rights><rights>Springer Science+Business Media New York 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c398t-d4ed7883119ef360c915cd2ad0d8849f41d3d5db5dcc13921c016d6fea093e1d3</citedby><cites>FETCH-LOGICAL-c398t-d4ed7883119ef360c915cd2ad0d8849f41d3d5db5dcc13921c016d6fea093e1d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-015-4656-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-015-4656-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26541736$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shinohara, Toshihiko</creatorcontrib><creatorcontrib>Kawano, Susumu</creatorcontrib><creatorcontrib>Tanaka, Yujiro</creatorcontrib><creatorcontrib>Fujisaki, Muneharu</creatorcontrib><creatorcontrib>Watanabe, Atsushi</creatorcontrib><creatorcontrib>Yamamoto, Katsuhiro</creatorcontrib><creatorcontrib>Hanyu, Nobuyoshi</creatorcontrib><title>Comparison of the cost and outcomes following totally laparoscopic and laparoscopy-assisted distal gastrectomies for gastric cancer: a single-institution comparison</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Objective
This study aimed to compare the short-term surgical outcomes and cost–benefits following totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for the treatment of gastric cancer.
Methods
Between April 2007 and December 2013, a total of 100 patients with gastric cancer underwent laparoscopic distal gastrectomy. The patients were classified into two groups according to whether intracorporeal anastomosis or extracorporeal anastomosis had been performed. The comparison between the groups was based on clinicopathological characteristics and surgical and economic outcomes.
Results
There were 57 and 43 patients who underwent TLDG and LADG, respectively. The patients’ demographics and tumor characteristics did not show any statistically significant differences with the exception for tumor location. In the LADG group, tumors were localized to relatively higher positions (
p
= 0.024) and received Roux-en-Y reconstruction more frequently (
p
< 0.001). There were no differences in the incidence of morbidity. Anastomotic leakage was not recorded in either group, although anastomotic stenosis occurred in one patient (1.8 %) after TLDG and in two patients (4.7 %) after LADG. Compared with the LADG group, the TLDG group was associated with significantly less operative blood loss (
p
< 0.001), a shorter time to oral intake (
p
= 0.012), and hospital stay (
p
= 0.018). The median operation costs were greater in the TLDG group than in the LADG group (¥982,000 in TLDG vs. ¥879,830 in LADG;
p
< 0.001), whereas the median total hospital costs were similar between the two groups (¥1302,665 in LADG vs. ¥1383,322 in TLDG:
p
= 0.119).
Conclusion
This study suggests that TLDG is as technically feasible, safe, and effective as LADG for treating patients with gastric cancer. Furthermore, TLDG is associated with equivalent total hospital costs compared with LADG. The increased operation cost is offset by the decreased costs associated with longer periods of hospitalization.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Blood Loss, Surgical</subject><subject>Cancer therapies</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Gastrectomy - economics</subject><subject>Gastrectomy - methods</subject><subject>Gastric cancer</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospital Costs</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Japan</subject><subject>Laparoscopy</subject><subject>Laparoscopy - economics</subject><subject>Laparotomy</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Stomach Neoplasms - surgery</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical anastomosis</subject><subject>Surgical outcomes</subject><subject>Tumors</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kc9u1DAQxi0EotvCA3BBlrhwcfHEjpNwQyv6R6rEBc6WazuLKydePI7Qvk8fFG9TCkLiNNLM7_s8no-QN8DPgfPuA3IulWQcWiZVqxg8IxuQomFNA_1zsuGD4KzpBnlCThHveMUHaF-Sk0a1EjqhNuR-m6a9yQHTTNNIy3dPbcJCzexoWopNk0c6phjTzzDvaEnFxHig0VRRQpv2wT6wfxoHZhADFu-oq8VEujNYsrclTeHBLK-dqrRmtj5_pIZidY-ehRlLKEsJdR37tNkr8mI0Ef3rx3pGvl18_rq9YjdfLq-3n26YFUNfmJPedX0vAAY_CsVt_ax1jXHc9b0cRglOuNbdts5aEEMDloNyavSmHsrX4Rl5v_ruc_qxeCx6Cmh9jGb2aUENPVdSdLwXFX33D3qXljzX7SoFAEIMA1QKVsrW22D2o97nMJl80MD1MUK9RqhrhPoYoT5q3j46L7eTd0-K35lVoFkBrKN55_NfT__X9RcaeKs7</recordid><startdate>20160801</startdate><enddate>20160801</enddate><creator>Shinohara, Toshihiko</creator><creator>Kawano, Susumu</creator><creator>Tanaka, Yujiro</creator><creator>Fujisaki, Muneharu</creator><creator>Watanabe, Atsushi</creator><creator>Yamamoto, Katsuhiro</creator><creator>Hanyu, Nobuyoshi</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20160801</creationdate><title>Comparison of the cost and outcomes following totally laparoscopic and laparoscopy-assisted distal gastrectomies for gastric cancer: a single-institution comparison</title><author>Shinohara, Toshihiko ; Kawano, Susumu ; Tanaka, Yujiro ; Fujisaki, Muneharu ; Watanabe, Atsushi ; Yamamoto, Katsuhiro ; Hanyu, Nobuyoshi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c398t-d4ed7883119ef360c915cd2ad0d8849f41d3d5db5dcc13921c016d6fea093e1d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Blood Loss, Surgical</topic><topic>Cancer therapies</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Gastrectomy - economics</topic><topic>Gastrectomy - methods</topic><topic>Gastric cancer</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospital Costs</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Japan</topic><topic>Laparoscopy</topic><topic>Laparoscopy - economics</topic><topic>Laparotomy</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Stomach Neoplasms - surgery</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical anastomosis</topic><topic>Surgical outcomes</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shinohara, Toshihiko</creatorcontrib><creatorcontrib>Kawano, Susumu</creatorcontrib><creatorcontrib>Tanaka, Yujiro</creatorcontrib><creatorcontrib>Fujisaki, Muneharu</creatorcontrib><creatorcontrib>Watanabe, Atsushi</creatorcontrib><creatorcontrib>Yamamoto, Katsuhiro</creatorcontrib><creatorcontrib>Hanyu, Nobuyoshi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shinohara, Toshihiko</au><au>Kawano, Susumu</au><au>Tanaka, Yujiro</au><au>Fujisaki, Muneharu</au><au>Watanabe, Atsushi</au><au>Yamamoto, Katsuhiro</au><au>Hanyu, Nobuyoshi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of the cost and outcomes following totally laparoscopic and laparoscopy-assisted distal gastrectomies for gastric cancer: a single-institution comparison</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2016-08-01</date><risdate>2016</risdate><volume>30</volume><issue>8</issue><spage>3573</spage><epage>3581</epage><pages>3573-3581</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Objective
This study aimed to compare the short-term surgical outcomes and cost–benefits following totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for the treatment of gastric cancer.
Methods
Between April 2007 and December 2013, a total of 100 patients with gastric cancer underwent laparoscopic distal gastrectomy. The patients were classified into two groups according to whether intracorporeal anastomosis or extracorporeal anastomosis had been performed. The comparison between the groups was based on clinicopathological characteristics and surgical and economic outcomes.
Results
There were 57 and 43 patients who underwent TLDG and LADG, respectively. The patients’ demographics and tumor characteristics did not show any statistically significant differences with the exception for tumor location. In the LADG group, tumors were localized to relatively higher positions (
p
= 0.024) and received Roux-en-Y reconstruction more frequently (
p
< 0.001). There were no differences in the incidence of morbidity. Anastomotic leakage was not recorded in either group, although anastomotic stenosis occurred in one patient (1.8 %) after TLDG and in two patients (4.7 %) after LADG. Compared with the LADG group, the TLDG group was associated with significantly less operative blood loss (
p
< 0.001), a shorter time to oral intake (
p
= 0.012), and hospital stay (
p
= 0.018). The median operation costs were greater in the TLDG group than in the LADG group (¥982,000 in TLDG vs. ¥879,830 in LADG;
p
< 0.001), whereas the median total hospital costs were similar between the two groups (¥1302,665 in LADG vs. ¥1383,322 in TLDG:
p
= 0.119).
Conclusion
This study suggests that TLDG is as technically feasible, safe, and effective as LADG for treating patients with gastric cancer. Furthermore, TLDG is associated with equivalent total hospital costs compared with LADG. The increased operation cost is offset by the decreased costs associated with longer periods of hospitalization.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>26541736</pmid><doi>10.1007/s00464-015-4656-1</doi><tpages>9</tpages></addata></record> |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Abdominal Surgery Adult Aged Aged, 80 and over Blood Loss, Surgical Cancer therapies Endoscopy Female Gastrectomy - economics Gastrectomy - methods Gastric cancer Gastroenterology Gastrointestinal surgery Gynecology Hepatology Hospital Costs Hospitalization Humans Japan Laparoscopy Laparoscopy - economics Laparotomy Length of Stay Male Medicine Medicine & Public Health Middle Aged Patients Proctology Retrospective Studies Stomach Neoplasms - surgery Surgeons Surgery Surgical anastomosis Surgical outcomes Tumors |
| title | Comparison of the cost and outcomes following totally laparoscopic and laparoscopy-assisted distal gastrectomies for gastric cancer: a single-institution comparison |
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