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Combined Endo-Laparoscopic Surgery is Significantly Less Costly than Traditional Surgery
Vol. 221, No. 4S1, October 2015
Scientific Forum Abstracts
RESULTS: Mice deficient in PGC1a within the intestinal epithelium undergoing antibiotic treatment during experimental colitis demonstrate a dramatic decrease in inflammatory cytokines within the intestine. They exhibit preservation of colonic architecture and minimal evidence of intestinal inflammation. CONCLUSIONS: We demonstrate that bacterial killing in the intestine with oral antibiotics during experimental colitis leads to decreased intestinal inflammation and improved gut architecture in PGC1aDIEC mice. 16S evaluation will reveal whether baseline differences in microbial composition exist in PGC1a DIEC mice that contribute to an increased susceptibility to colitis. Strategies aimed at enhancing PGC1a activity and altering the intestinal microbiome may improve treatment regimens for human IBD. Combined Endo-Laparoscopic Surgery is Significantly Less Costly than Traditional Surgery Sameer Sharma, MD, Jia Xing, Kentaro Nakajima, MD, Jeffrey Milsom, MD, FACS Weill Cornell Medical College, New York, NY INTRODUCTION: Despite the purported patient benefits of combined endo-laparoscopic surgery (CELS)dalso known as “rendezvous” proceduresdfor treatment of large colorectal polyps and early carcinoma, its economic impact remains unclear. The CELS procedures use endoscopic removal of lesions that would otherwise require intestinal resection and hospital stay (up to 7 days). The typical length of stay (LOS) after a CELS procedure is 1 day. Published cost estimates for individual procedures vary widely and typically report institutional costs derived from gross-costing methods, eg, coding. METHODS: Here we set out to perform a cost analysis of CELS compared with laparoscopic-assisted and open segmental resection.
Polypectomy procedures costs
Fixed costs Hospital fixed, $/procedure LOS, d Capital equipment, $/procedure Variable costs, average person cost, $ Conversion cost, to higher form of surgery, $ Post-histology formal resection Failure of current form and higher Rx, $ Average equipment cost, $ Cost Anesthesia cost Total cost of procedure, $ CELS saving, %
CELS Laparoscopic
2,214 1 416 959
8,856 4 365 1,749
63
91
Open
15,498 7 284 1,262
1,255 1,414 233 6,554
1,229 304 12,595 47
CELS, combined endo-laparoscopic surgery; LOS, length of stay.
922 251 18,216 64
S29
Using institutional and micro-costing data from the literature we determined the estimated cost (Table). RESULTS: The estimated cost for CELS was $6,554 compared with segmental resection at $12,595 (laparoscopic assisted) and $18,216 (open). The LOS was the largest factor contributing to the decreased hospital costs seen with CELS (1 day vs 4 laparoscopic and 7 open). CONCLUSIONS: Compared with standard treatment, CELS is less costly, providing an estimated 47% to 64% cost-savings compared with traditional surgery. Our analysis included the costs for possible formal resection post histologic analysis. Given similar patient outcomes compared with traditional methods, these data should guide policy makers to consider procedures such as CELS as the most cost-effective treatment option available. Complete Clinical Response after Neoadjuvant Chemoradiotherapy Managed Nonoperatively Results in Better Anorectal Function When Compared with Other Sphincter-Saving Alternatives for Distal Rectal Cancer Guilherme Sao Juliao, Patricio B Lynn, MD, Angelita Habr-Gama, MD, FACS(Hon), Rodrigo O Perez, MD, PhD, Igor Proscurshim, MD, Rafael Ulysses Azevedo, Felipe Alexandre Fernandes, Jose Marcio J Neves, MD, Joaquim Gama-Rodrigues, MD, PhD, FACS(Hon) Angelita and Joaquim Gama Institute, Sao Paulo, Brazil INTRODUCTION: It has been suggested that nonoperative management or transanal endoscopic microsurgery (TEM) could result in better anorectal function and quality of life when compared with radical TEM with sphincter-preservation for patients with complete response after neoadjuvant chemoradiotherapy (CRT). The purpose of this study was to compare anorectal function and quality of life between patients before CRT and after different sphincter- and organ-preserving strategies. METHODS: Consecutive patients with distal rectal cancer undergoing neoadjuvant CRT were assessed for anorectal function with manometry, Cleveland Clinic Incontinence Index (CCII), and Fecal Incontinence Quality of Life (FIQL) questionnaires. Assessment was performed after CRT completion after 1 of the 3 alternatives: radical surgery with sphincter preservation (SP), TEM and nonoperative management (WW). An independent group of patients with rectal cancer before CRT was assessed and constituted the control group. RESULTS: Overall, 91 patients were assessed: 53 after WW, 29 after TEM, and 9 after radical surgery (Table). The control group included 14 patients. Patients in the WW group had lower resting pressures compared with the control group. Patients undergoing TEM and radical surgery had worse manometric findings, CCII, and FIQL, when compared with the control group.There were no differences between radical surgery and TEM. However, patients managed nonoperatively had significantly better CCII, FIQL results, and manometric findings.
Scientific Forum Abstracts
RESULTS: Mice deficient in PGC1a within the intestinal epithelium undergoing antibiotic treatment during experimental colitis demonstrate a dramatic decrease in inflammatory cytokines within the intestine. They exhibit preservation of colonic architecture and minimal evidence of intestinal inflammation. CONCLUSIONS: We demonstrate that bacterial killing in the intestine with oral antibiotics during experimental colitis leads to decreased intestinal inflammation and improved gut architecture in PGC1aDIEC mice. 16S evaluation will reveal whether baseline differences in microbial composition exist in PGC1a DIEC mice that contribute to an increased susceptibility to colitis. Strategies aimed at enhancing PGC1a activity and altering the intestinal microbiome may improve treatment regimens for human IBD. Combined Endo-Laparoscopic Surgery is Significantly Less Costly than Traditional Surgery Sameer Sharma, MD, Jia Xing, Kentaro Nakajima, MD, Jeffrey Milsom, MD, FACS Weill Cornell Medical College, New York, NY INTRODUCTION: Despite the purported patient benefits of combined endo-laparoscopic surgery (CELS)dalso known as “rendezvous” proceduresdfor treatment of large colorectal polyps and early carcinoma, its economic impact remains unclear. The CELS procedures use endoscopic removal of lesions that would otherwise require intestinal resection and hospital stay (up to 7 days). The typical length of stay (LOS) after a CELS procedure is 1 day. Published cost estimates for individual procedures vary widely and typically report institutional costs derived from gross-costing methods, eg, coding. METHODS: Here we set out to perform a cost analysis of CELS compared with laparoscopic-assisted and open segmental resection.
Polypectomy procedures costs
Fixed costs Hospital fixed, $/procedure LOS, d Capital equipment, $/procedure Variable costs, average person cost, $ Conversion cost, to higher form of surgery, $ Post-histology formal resection Failure of current form and higher Rx, $ Average equipment cost, $ Cost Anesthesia cost Total cost of procedure, $ CELS saving, %
CELS Laparoscopic
2,214 1 416 959
8,856 4 365 1,749
63
91
Open
15,498 7 284 1,262
1,255 1,414 233 6,554
1,229 304 12,595 47
CELS, combined endo-laparoscopic surgery; LOS, length of stay.
922 251 18,216 64
S29
Using institutional and micro-costing data from the literature we determined the estimated cost (Table). RESULTS: The estimated cost for CELS was $6,554 compared with segmental resection at $12,595 (laparoscopic assisted) and $18,216 (open). The LOS was the largest factor contributing to the decreased hospital costs seen with CELS (1 day vs 4 laparoscopic and 7 open). CONCLUSIONS: Compared with standard treatment, CELS is less costly, providing an estimated 47% to 64% cost-savings compared with traditional surgery. Our analysis included the costs for possible formal resection post histologic analysis. Given similar patient outcomes compared with traditional methods, these data should guide policy makers to consider procedures such as CELS as the most cost-effective treatment option available. Complete Clinical Response after Neoadjuvant Chemoradiotherapy Managed Nonoperatively Results in Better Anorectal Function When Compared with Other Sphincter-Saving Alternatives for Distal Rectal Cancer Guilherme Sao Juliao, Patricio B Lynn, MD, Angelita Habr-Gama, MD, FACS(Hon), Rodrigo O Perez, MD, PhD, Igor Proscurshim, MD, Rafael Ulysses Azevedo, Felipe Alexandre Fernandes, Jose Marcio J Neves, MD, Joaquim Gama-Rodrigues, MD, PhD, FACS(Hon) Angelita and Joaquim Gama Institute, Sao Paulo, Brazil INTRODUCTION: It has been suggested that nonoperative management or transanal endoscopic microsurgery (TEM) could result in better anorectal function and quality of life when compared with radical TEM with sphincter-preservation for patients with complete response after neoadjuvant chemoradiotherapy (CRT). The purpose of this study was to compare anorectal function and quality of life between patients before CRT and after different sphincter- and organ-preserving strategies. METHODS: Consecutive patients with distal rectal cancer undergoing neoadjuvant CRT were assessed for anorectal function with manometry, Cleveland Clinic Incontinence Index (CCII), and Fecal Incontinence Quality of Life (FIQL) questionnaires. Assessment was performed after CRT completion after 1 of the 3 alternatives: radical surgery with sphincter preservation (SP), TEM and nonoperative management (WW). An independent group of patients with rectal cancer before CRT was assessed and constituted the control group. RESULTS: Overall, 91 patients were assessed: 53 after WW, 29 after TEM, and 9 after radical surgery (Table). The control group included 14 patients. Patients in the WW group had lower resting pressures compared with the control group. Patients undergoing TEM and radical surgery had worse manometric findings, CCII, and FIQL, when compared with the control group.There were no differences between radical surgery and TEM. However, patients managed nonoperatively had significantly better CCII, FIQL results, and manometric findings.