Intrathoracic versus cervical anastomosis after totally or hybrid minimally invasive transthoracic oesophagectomy for oesophageal cancer: cost-effectiveness analysis alongside the randomized ICAN trial.

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2025-05-07 DOI:10.1093/bjsopen/zraf061
Eric Matthée, Sander Ubels, Bastiaan Klarenbeek, Moniek H P Verstegen, Gerjon Hannink, Frans van Workum, Camiel Rosman, Janneke P C Grutters
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Abstract

Background: There is a worldwide trend towards minimally invasive oesophagectomy with intrathoracic anastomosis in oesophageal cancer surgery. Minimally invasive oesophagectomy with intrathoracic anastomosis has been shown to result in fewer anastomotic leaks, but cost-effectiveness is yet to be established. The aim of this study was to determine the cost-effectiveness of transthoracic minimally invasive oesophagectomy with intrathoracic anastomosis compared with cervical anastomosis.

Methods: A prospective economic evaluation was performed alongside the ICAN trial, a randomized clinical superiority trial. Patients with mid/distal oesophageal or gastro-oesophageal junction cancer were randomly assigned to transthoracic minimally invasive oesophagectomy with either intrathoracic or cervical anastomosis. Quality-adjusted life-years, mean healthcare, and societal costs were assessed for both groups at 9 and 21 months after surgery.

Results: A total of 245 patients randomized for transthoracic minimally invasive oesophagectomy with either intrathoracic (122) or cervical (123) anastomosis were included in the cost-effectiveness analysis. After 9 months, the intrathoracic group yielded 0.58 (95% confidence interval (c.i.) 0.55 to 0.61) quality-adjusted life-years per patient, compared with 0.56 (0.52 to 0.58) quality-adjusted life-years for the cervical group. After 9 months, both mean healthcare costs (20 573 (95% c.i. 17 623 to 24 177) versus 28 039 (23 574 to 33 116) euros), and societal costs (24 590 (21 237 to 29 074) versus 33 383 (27 885 to 38 805) euros), per patient were lower in the intrathoracic anastomosis group. Similarly, at 21 months no statistically significant difference was found (mean difference 0.08 (-0.05 to 0.2) quality-adjusted life-years), whereas minimally invasive oesophagectomy with intrathoracic anastomosis was less costly than that with cervical anastomosis (mean difference -9930 (-16 301 to -2521) euros). The higher costs in the cervical anastomosis group were mainly due to longer lengths of stay owing to complications.

Conclusion: Transthoracic minimally invasive oesophagectomy with intrathoracic anastomosis was found to be cost-effective compared with transthoracic minimally invasive oesophagectomy with cervical anastomosis.

经胸微创食管癌全切除术或混合型食管癌术后胸内吻合与颈内吻合:随机ICAN试验的成本-效果分析
背景:在食管癌手术中采用微创食管切除术加胸内吻合是一种世界性的趋势。微创食管切除术加胸内吻合术已被证明能减少吻合口漏,但成本-效果尚未确定。本研究的目的是确定经胸微创食管切除术与胸内吻合与颈吻合的成本-效果。方法:在ICAN试验(一项随机临床优势试验)的同时进行前瞻性经济评价。中/远端食管癌或胃-食管癌患者被随机分配到经胸微创食管切除术,胸内或颈内吻合。在术后9个月和21个月对两组的质量调整生命年、平均医疗保健和社会成本进行评估。结果:随机选取245例经胸微创食管切除术患者进行成本-效果分析,其中122例为胸内吻合,123例为颈内吻合。9个月后,胸内组每位患者的质量调整生命年为0.58(95%可信区间(ci) 0.55 ~ 0.61),而颈椎组的质量调整生命年为0.56(0.52 ~ 0.58)。9个月后,胸内吻合组每位患者的平均医疗成本(20 573欧元(95% ci: 17 623至24 177欧元)比28 039欧元(23 574至33 116欧元)低,社会成本(24 590欧元(21 237至29 074欧元)比33 383欧元(27 885至38 805欧元)低。同样,在21个月时,没有发现有统计学意义的差异(平均差异0.08(-0.05至0.2)质量调整生命年),而微创食管切除术胸内吻合术的成本低于颈吻合术(平均差异-9930(-16 301至-2521)欧元)。颈吻合术组费用较高主要是由于并发症导致住院时间较长。结论:经胸微创食管切除术加胸内吻合较经胸微创食管切除术加颈吻合更具成本效益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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