Abstract：
BACKGROUND: We aimed to compare outcomes and cost effectiveness of extra-corporeal anastomosis (ECA) versus intra-corporeal anastomosis (ICA) for laparoscopic right hemicolectomy using the National Surgical Quality Improvement Programme data.
METHODS: Patients who underwent elective laparoscopic right hemicolectomy for colon cancer from January 2018 to December 2022 were identified. Non-cancer diagnoses, emergency procedures or synchronous resection of other organs were excluded. Surgical characteristics, peri-operative outcomes, long-term survival and hospitalisation costs were compared. Incremental cost-effectiveness ratio (ICER) was used to evaluate cost-effectiveness.
RESULTS: A total of 223 patients (175 ECA, 48 ICA) were included in the analysis. Both cohorts exhibited comparable baseline patient, comorbidity, and tumour characteristics. Distribution of pathological TMN stage, tumour largest dimension, total lymph node harvest and resection margin lengths were statistically similar. ICA was associated with a longer median operative duration compared with ECA (255 min vs. 220 min, P < 0.001). There was a quicker time to gastrointestinal recovery, with a shorter median hospital stay in the ICA group (4.0 versus 5.0 days, P = 0.001). Overall complication rates were comparable. ICA was associated with a higher surgical procedure cost (£6301.57 versus £4998.52, P < 0.001), but lower costs for ward accommodation (£1679.05 versus £2420.15, P = 0.001) and treatment (£3774.55 versus £4895.14, P = 0.009), with a 4.5% reduced overall cost compared with ECA. The ICER of -£3323.58 showed ICA to be more cost effective than ECA, across a range of willingness-to-pay thresholds.
CONCLUSIONS: ICA in laparoscopic right hemicolectomy is associated with quicker post-operative recovery and may be more cost effective compared with ECA, despite increased operative costs.
METHODS: Patients who underwent elective laparoscopic right hemicolectomy for colon cancer from January 2018 to December 2022 were identified. Non-cancer diagnoses, emergency procedures or synchronous resection of other organs were excluded. Surgical characteristics, peri-operative outcomes, long-term survival and hospitalisation costs were compared. Incremental cost-effectiveness ratio (ICER) was used to evaluate cost-effectiveness.
RESULTS: A total of 223 patients (175 ECA, 48 ICA) were included in the analysis. Both cohorts exhibited comparable baseline patient, comorbidity, and tumour characteristics. Distribution of pathological TMN stage, tumour largest dimension, total lymph node harvest and resection margin lengths were statistically similar. ICA was associated with a longer median operative duration compared with ECA (255 min vs. 220 min, P < 0.001). There was a quicker time to gastrointestinal recovery, with a shorter median hospital stay in the ICA group (4.0 versus 5.0 days, P = 0.001). Overall complication rates were comparable. ICA was associated with a higher surgical procedure cost (£6301.57 versus £4998.52, P < 0.001), but lower costs for ward accommodation (£1679.05 versus £2420.15, P = 0.001) and treatment (£3774.55 versus £4895.14, P = 0.009), with a 4.5% reduced overall cost compared with ECA. The ICER of -£3323.58 showed ICA to be more cost effective than ECA, across a range of willingness-to-pay thresholds.
CONCLUSIONS: ICA in laparoscopic right hemicolectomy is associated with quicker post-operative recovery and may be more cost effective compared with ECA, despite increased operative costs.
摘要：
背景：我们的目的是比较体外吻合术（ECA）和体内吻合术（ICA）在腹腔镜右半结肠切除术中的效果和成本效益。
方法：确定2018年1月至2022年12月接受择期腹腔镜右半结肠切除术治疗结肠癌的患者。非癌症诊断，紧急手术或同步切除其他器官被排除.手术特点,围手术期结果，比较了长期生存率和住院费用.采用增量成本-效果比(ICER)评价成本-效果。
结果：总共223例患者（175例ECA，48个ICA)被包括在分析中。两组均表现出相当的基线患者，合并症，和肿瘤特征。病理TMN分期分布,肿瘤最大尺寸，总淋巴结收获和切除边缘长度在统计学上相似.与ECA相比，ICA的中位手术时间更长（255分钟与220分钟,P<0.001)。胃肠道恢复的时间更快，ICA组的中位住院时间较短(4.0天对5.0天，P=0.001)。总体并发症发生率相当。ICA与较高的手术费用相关（6301.57英镑对4998.52英镑，P<0.001），但病房住宿费用(1679.05英镑对2420.15英镑，P=0.001)和治疗费用(3774.55英镑对4895.14英镑，P=0.009)较低，与ECA相比，总成本降低了4.5%。ICER-3323.58英镑显示ICA比ECA更具成本效益，跨越一系列支付意愿门槛。
结论：与ECA相比，腹腔镜右半结肠切除术中的ICA与术后恢复更快相关，并且可能更具成本效益。尽管手术成本增加。
方法：确定2018年1月至2022年12月接受择期腹腔镜右半结肠切除术治疗结肠癌的患者。非癌症诊断，紧急手术或同步切除其他器官被排除.手术特点,围手术期结果，比较了长期生存率和住院费用.采用增量成本-效果比(ICER)评价成本-效果。
结果：总共223例患者（175例ECA，48个ICA)被包括在分析中。两组均表现出相当的基线患者，合并症，和肿瘤特征。病理TMN分期分布,肿瘤最大尺寸，总淋巴结收获和切除边缘长度在统计学上相似.与ECA相比，ICA的中位手术时间更长（255分钟与220分钟,P<0.001)。胃肠道恢复的时间更快，ICA组的中位住院时间较短(4.0天对5.0天，P=0.001)。总体并发症发生率相当。ICA与较高的手术费用相关（6301.57英镑对4998.52英镑，P<0.001），但病房住宿费用(1679.05英镑对2420.15英镑，P=0.001)和治疗费用(3774.55英镑对4895.14英镑，P=0.009)较低，与ECA相比，总成本降低了4.5%。ICER-3323.58英镑显示ICA比ECA更具成本效益，跨越一系列支付意愿门槛。
结论：与ECA相比，腹腔镜右半结肠切除术中的ICA与术后恢复更快相关，并且可能更具成本效益。尽管手术成本增加。
