Comparing the clinical and economic impact of laparoscopic versus open liver resection. Ann Surg Oncol 2010 Apr;17(4):998-1009
Date
12/25/2009Pubmed ID
20033324Pubmed Central ID
PMC3119901DOI
10.1245/s10434-009-0839-0Scopus ID
2-s2.0-77952092285 (requires institutional sign-in at Scopus site) 124 CitationsAbstract
BACKGROUND: Laparoscopic liver resection has thus far not gained widespread acceptance among liver surgeons. Valid questions remain regarding the relative clinical superiority of the laparoscopic approach as well as whether laparoscopic hepatectomy carries any economic benefit compared with open liver surgery.
OBJECTIVE: The aim of this work is to compare the clinical and economic impact of laparoscopic versus open left lateral sectionectomy (LLS).
METHODS: Between May 2002 and July 2008, 44 laparoscopic LLS and 29 open LLS were included in the analysis. Deviation-based cost modeling (DBCM) was utilized to compare the combined clinical and economic impact of the open and laparoscopic approaches.
RESULTS: The laparoscopic approach compared favorably with the open approach from both a clinical and economic standpoint. Not only was the median length of stay (LOS) shorter by 2 days in the laparoscopic group (3 versus 5 days, respectively, P = 0.001), but the laparoscopic cohort also benefited from a significant reduction in postoperative morbidity (P = 0.001). Because the groups differed significantly in age and ratio of benign to malignant disease, a subgroup analysis limited to patients with malignant disease was undertaken. The same reduction in LOS and postoperative morbidity was evident within the malignant subgroup undergoing laparoscopic LLS (P = 0.003). The economic impact of the laparoscopic approach was noteworthy, with the laparoscopic approach US$1,527-2,939 more cost efficient per patient compared with the open technique.
CONCLUSION: Our study seems not only to corroborate the safety and clinical benefit of the laparoscopic approach but also suggests a fiscally important cost advantage for the minimally invasive approach.
Author List
Vanounou T, Steel JL, Nguyen KT, Tsung A, Marsh JW, Geller DA, Gamblin TCAuthor
Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Female
Hepatectomy
Humans
Laparoscopy
Liver Neoplasms
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Survival Rate
Treatment Outcome
Young Adult
