Comparative Study on the Effectiveness, Safety, and Economic Costs of Endoscopic Submucosal Dissection for Colorectal Tumors Under Conscious Sedation and General Anesthesia.

IF 1.1 4区 医学 Q3 SURGERY
Yanrong Li, Jing Wang, Ye Hong, Qi Wu
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Abstract

Background: Endoscopic submucosal dissection (ESD) is a minimally invasive surgical procedure used for en bloc removal of colorectal tumors. Although colorectal ESD is ideally conducted under conscious sedation, it is often performed under general anesthesia because of its complexity and lengthy duration. Currently, there is limited research on colorectal ESD performed under conscious sedation. The purpose of this study was to evaluate the effectiveness, safety, and economic cost of colorectal ESD under conscious sedation compared to general anesthesia.

Materials and methods: Retrospective analysis of 301 patients who underwent ESD treatment for colorectal tumors at the Endoscopy Center of Peking University Cancer Hospital from January 2018 to November 2020. Patients were divided into the sedation group (group S, n=88) and the general anesthesia group (group A, n=213) based on the anesthetic method. To balance the confounding factors between the 2 groups, 75 matched pairs were obtained after using propensity score matching (PSM). Intraoperative and postoperative parameters were then compared between the matched groups.

Results: After PSM, there was no statistically significant difference between group S and group A in terms of the surgical time, en bloc resection rate, and complete resection rate. There was also no statistically significant difference in the occurrence rates of bleeding, perforation, and post-ESD electrocoagulation syndrome (PEECS) between the 2 groups. However, the length of hospital stay was significantly shorter in group S (1.23±0.89d) than in group A (5.92±3.05d) ( P <0.05). The hospitalization costs were also significantly lower in group S (16482.34±13154.32 yuan) compared with group A (34743.74±13779.40 yuan) (P < 0.05 ).

Conclusions: Compared to general anesthesia, performing ESD for colorectal tumors under conscious sedation has equivalent effectiveness and safety while shortening the hospital stay and reducing the economic costs.

意识镇静和全身麻醉下内镜黏膜下切除术治疗结直肠肿瘤的有效性、安全性和经济成本比较研究
背景:内镜黏膜下剥离术(ESD)是一种微创外科手术,用于结直肠肿瘤的整体切除。虽然结直肠ESD最好在有意识镇静的情况下进行,但由于其复杂性和持续时间较长,通常在全身麻醉的情况下进行。目前,关于在有意识镇静状态下进行结直肠ESD的研究还很有限。本研究旨在评估与全身麻醉相比,在有意识镇静状态下进行结肠直肠ESD的有效性、安全性和经济成本:回顾性分析2018年1月至2020年11月在北京大学肿瘤医院内镜中心接受ESD治疗的301例结直肠肿瘤患者。根据麻醉方式将患者分为镇静组(S组,n=88)和全身麻醉组(A组,n=213)。为平衡两组间的混杂因素,采用倾向得分匹配法(PSM)获得了 75 对匹配组。然后比较配对组的术中和术后参数:结果:经过倾向评分匹配后,S 组与 A 组在手术时间、全灶切除率和完全切除率方面的差异无统计学意义。两组的出血率、穿孔率和ESD后电凝综合征(PEECS)发生率差异也无统计学意义。不过,S 组的住院时间(1.23±0.89d)明显短于 A 组(5.92±3.05d)(PC 结论:与全身麻醉相比,电凝术后的出血、穿孔和电凝后综合征的发生率在统计学上无明显差异:与全身麻醉相比,在清醒镇静状态下进行结直肠肿瘤ESD治疗具有同等的有效性和安全性,同时还能缩短住院时间并降低经济成本。
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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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