Cost-Effectiveness of Minimally Invasive Esophagectomy for Esophageal Squamous Cell Carcinoma

2018 ◽  
Vol 42 (8) ◽  
pp. 2522-2529 ◽  
Author(s):  
Chao-Yu Liu ◽  
Chen-Sung Lin ◽  
Chih-Shiun Shih ◽  
Yuh-An Huang ◽  
Chia-Chuan Liu ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cost Effectiveness ◽  
Esophageal Squamous Cell Carcinoma ◽  
Minimally Invasive ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Minimally Invasive Esophagectomy ◽  
Invasive Esophagectomy

PS02.014: COST-EFFECTIVENESS OF MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 124-124
Author(s):  
Chao-Yu Liu ◽  
Chia-Chuan Liu
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cost Effectiveness ◽  
Esophageal Squamous Cell Carcinoma ◽  
Minimally Invasive ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Minimally Invasive Esophagectomy ◽  
Invasive Esophagectomy ◽  
The Cost ◽  
Cost Studies

Abstract Background The cost-effectiveness of minimally invasive esophagectomy (MIE) versus open esophagectomy (OE) for esophageal squamous cell carcinoma (ESCC) has not been established. Recent cost studies have shown that MIE is associated with a higher surgical expense, which is not consistently offset by savings through expedited post-operative recovery, therefore suggesting a questionable benefit of MIE over OE from an economic point of view. In the current study, we compared the cost-effectiveness of MIE versus OE for ESCC. Methods Between April 2000 and December 2013, a total of 251 consecutive patients undergoing MIE or OE for ESCC were enrolled. After propensity score (PS)-matching the MIE group with the OE group for clinical characteristics, 95 patients from each group were enrolled to compare the peri-operative outcomes, long-term survival, and cost. Results After PS-matching, the baseline characteristics were not significantly different between groups. Perioperative outcomes were similar in both groups. MIE was superior to OE with respect to a shorter intensive care unit (ICU) stay, while the complication rate (except for hoarseness) and survival were similar. Post-operative cost was significantly less in the MIE group due to a shorter ICU stay; however, reduced post-operative cost failed to offset the higher surgical expense of MIE. Conclusion MIE for ESCC failed to show cost-effectiveness regarding overall expense in our study, but costs less in the postoperative care, especially for ICU care. More cost studies on MIE in other health care systems are warranted to verify the cost-effectiveness of MIE. Disclosure All authors have declared no conflicts of interest.

Does robot-assisted minimally invasive esophagectomy really have the advantage of lymphadenectomy over video-assisted minimally invasive esophagectomy in treating esophageal squamous cell carcinoma? A propensity score-matched analysis based on short-term outcomes

2018 ◽  
Vol 32 (7) ◽  
Author(s):  
H-Y Deng ◽  
J Luo ◽  
S-X Li ◽  
G Li ◽  
G Alai ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Propensity Score ◽  
Esophageal Squamous Cell Carcinoma ◽  
Minimally Invasive ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Minimally Invasive Esophagectomy ◽  
Invasive Esophagectomy ◽  
Major Complications

SUMMARY This study aims to investigate advantages of robot-assisted minimally invasive esophagectomy (RAMIE) over video-assisted minimally invasive esophagectomy (VAMIE) in treating esophageal squamous cell carcinoma by applying propensity score-matched analysis. From April 2016 to January 2018, consecutive patients undergoing a McKeown RAMIE or VAMIE for esophageal squamous cell carcinoma were prospectively included for analysis. Baseline data, pathological findings, and short-term outcomes of the two groups (RAMIE group and VAMIE group) were collected and compared. Propensity score-matched analysis was applied to generate matched pairs for further comparison. Finally, we included a total of 151 patients (RAMIE group: 79 patients, VAMIE group: 72 patients) for analysis. In the analysis of unmatched cohort, RAMIE yielded a significantly larger number of total dissected lymph nodes (mean: 20.6 ± 8.8 vs. 17.9 ± 7.7; P = 0.048) and abdominal lymph nodes (mean: 9.5 ± 6.8 vs. 7.4 ± 5.1; P = 0.039) than VAMIE. However, there was no significantly different risk of major complications between the two groups. In the analysis of matched cohort, RAMIE still yielded a significantly larger number of total dissected lymph nodes (P = 0.006) and abdominal lymph nodes (P = 0.042) than VAMIE. There was still no increased risk of postoperative major complications in the RAMIE group compared to the VAMIE group. Moreover, RAMIE was found to yield significantly more left recurrent laryngeal nerve lymph nodes (mean: 1.0 ± 1.8 vs. 0.4 ± 0.8; P = 0.033) than VAMIE without increasing the risk of recurrent laryngeal nerve paralysis. Therefore, RAMIE may have the advantage of lymphadenectomy over VAMIE without increasing any risk of postoperative major complications. Further well-conducted studies, however, are needed to confirm our conclusions.

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