Evidence from quality of life studies is inconsistent; with a recent systematic review reporting that some studies suggest no significant difference, whilst others suggest a significant quality of life benefit with the laparoscopic approach.
Readmission rates are typically lower, but not significant, in patients undergoing laparoscopic colorectal resection than in those undergoing open colorectal resection.([FOOTNOTE=Fowler DL, White A. Laparoscopy-assisted sigmoid resection. Surg Laparosc Endosc. 1991 Sep;1(3):183-8.],[ANCHOR=],[LINK=]),([FOOTNOTE=Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991 Sept;1: 144–150.],[ANCHOR=],[LINK=])
Rates of readmission are influenced by several factors including BMI, surgeon volume, operating time and presence of SSI; ([FOOTNOTE=Manilich E, Vogel JD, Kiran RP, et al. Key factors associated with postoperative complications in patients undergoing colorectal surgery. Dis Colon Rectum. 2013 Jan;56(1):64-71.],[ANCHOR=],[LINK=]),([FOOTNOTE=Wick EC, Shore AD, Hirose K, et al. Readmission rates and cost following colorectal surgery. Dis Colon Rectum. 2011 Dec;54(12):1475-9.],[ANCHOR=],[LINK=]) increased BMI is also associated with an increased surgical difficulty and significantly increased risk for SSI.([FOOTNOTE=Yang T, Wei M, He Y, Deng X, Wang Z. Impact of visceral obesity on outcomes of laparoscopic colorectal surgery: a meta-analysis. ANZ J Surg. 2015 Apr 22. doi: 10.1111/ans.13132. [Epub ahead of print]],[ANCHOR=],[LINK=]),([FOOTNOTE=Wick EC, Hirose K, Shore AD, et al. Surgical site infections and cost in obese patients undergoing colorectal surgery. Arch Surg. 2011 Sep;146(9):1068-72.],[ANCHOR=],[LINK=])
In published cost studies the percentage difference between laparoscopic and open colectomy varies widely, but for studies conducted in Western settings there is a trend toward a decline in the cost of laparoscopic colectomy over time.
Higher surgeon volume is associated with better outcomes and lower costs compared with low volume surgeons.
Clinical outcomes reported in studies of laparoscopic versus open colectomy in emerging markets such as India and Brazil are similar to outcomes reported in Europe and North America.([FOOTNOTE=Lacy AM, Delgado S, García-Valdecasas JC, et al. Port site metastases and recurrence after laparoscopic colectomy. A randomized trial. Surg Endosc. 1998 Aug;12(8):1039-42.],[ANCHOR=],[LINK=])
Laparoscopic surgery is associated with lower absolute risk of pulmonary complications versus open surgery.([FOOTNOTE=Owen RM, Perez SD, Lytle N, et al. Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy. Surg Endosc. 2013 Oct;27(10):3555-63.],[ANCHOR=],[LINK=])
Laparoscopic surgery for colorectal cancer is now associated with similar outcomes to open surgery in terms of overall survival, disease-free survival and port-site metastases.([FOOTNOTE=Bărbulescu M, Alecu L, Boeţi P, Popescu I. Port-site metastasis after laparoscopic surgery for colorectal cancer--still a real concern? Case report and review of the literature. Chirurgia (Bucur). 2012 Jan-Feb;107(1):103-7.],[ANCHOR=],[LINK=]),([FOOTNOTE=Martel G, Crawford A, Barkun JS, et al. Expert opinion on laparoscopic surgery for colorectal cancer parallels evidence from a cumulative meta-analysis of randomized controlled trials. PLoS One. 2012;7(4):e35292.],[ANCHOR=],[LINK=]),([FOOTNOTE=Wilson MZ, Hollenbeak CS, Stewart DB. Laparoscopic colectomy is associated with a lower incidence of postoperative complications than open colectomy: a propensity score-matched cohort analysis. Colorectal Dis. 2014 May;16(5):382-9.],[ANCHOR=],[LINK=]),([FOOTNOTE=SEER Stat Fact Sheets. Colon and Rectum Cancer. National Cancer Institute (United States) Website. Accessed July 27, 2015.],[ANCHOR=View Stat Facts],[LINK=http://seer.cancer.gov/statfacts/html/colorect.html]),([FOOTNOTE=Ito N, Tanaka M, Kazuma K. Health-related quality of life among persons living in Japan with a permanent colostomy. J Wound Ostomy Continence Nurs. 2005 May-Jun;32(3):178-83.],[ANCHOR=],[LINK=]),([FOOTNOTE=Laparoscopic surgery for colorectal cancer. National Institute for Health and Care Excellence Website. Accessed Oct 5, 2015.],[ANCHOR=View NICE Guidance],[LINK=https://www.nice.org.uk/guidance/ta105])
There is no significant difference between laparoscopic and open colorectal surgery for colorectal cancer in terms of overall survival rates 9-11, 13,14, ([FOOTNOTE=Kiran RP, Kirat HT, Ozturk E, Geisler DP, Remzi FH. Does the learning curve during laparoscopic colectomy adversely affect costs? Surg Endosc. 2010 Nov;24(11):2718-22.],[ANCHOR=],[LINK=]),([FOOTNOTE=Damle RN, Macomber CW, Flahive JM, et al. Surgeon volume and elective resection for colon cancer: an analysis of outcomes and use of laparoscopy. J Am Coll Surg. 2014 Jun;218(6):1223-30.],[ANCHOR=],[LINK=])
Length of hospital stay is significantly shorter following laparoscopic colorectal surgery than with open colorectal surgery.1,2,6,8,12,([FOOTNOTE=Bartels SA, Vlug MS, Ubbink DT, Bemelman WA. Quality of life after laparoscopic and open colorectal surgery: a systematic review. World J Gastroenterol. 2010 Oct 28;16(40):5035-41.],[ANCHOR=],[LINK=]),([FOOTNOTE=Aly OE, Quayyum Z. Has laparoscopic colorectal surgery become more cost-effective over time? Int J Colorectal Dis. 2012 Jul;27(7):855-60.],[ANCHOR=],[LINK=]),([FOOTNOTE=Wang CL, Qu G, Xu HW. The short- and long-term outcomes of laparoscopic versus open surgery for colorectal cancer: a meta-analysis. Int J Colorectal Dis. 2014 Mar;29(3):309-20.],[ANCHOR=],[LINK=]),([FOOTNOTE=Ma Y, Yang Z, Qin H, Wang Y. A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer. Med Oncol. 2011 Dec;28(4):925-33.],[ANCHOR=],[LINK=])
Blood loss during surgery is significantly lower with laparoscopic versus open colorectal surgery.6,([FOOTNOTE=Ohtani H, Tamamori Y, Arimoto Y, et al. A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and conventional open surgery for colorectal cancer. J Cancer. 2011;(2):425-34.],[ANCHOR=],[LINK=]),([FOOTNOTE=Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD003432.],[ANCHOR=],[LINK=]),([FOOTNOTE=Di B, Li Y, Wei K, et al. Laparoscopic versus open surgery for colon cancer: a meta-analysis of 5-year follow-up outcomes. Surg Oncol. 2013 Sep;22(3):e39-43.],[ANCHOR=],[LINK=])
Longer operating time is not associated with significantly higher costs.15
Findings from cost studies are inconsistent. In instances where total costs were lower with laparoscopic versus open colorectal surgery the cost savings were primarily driven by lower complication rates.
Clinical benefits of laparoscopic colectomy, including shorter length of stay and lower rates of postoperative complications translate into economic benefits, which are important from the payer perspective.
In US-based studies, total hospital costs for laparoscopic colorectal resection were generally lower than for open colorectal resection.([FOOTNOTE=Kang CY, Chaudhry OO, Halabi WJ, et al. Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. Am J Surg. 2012 Dec;204(6):952-7.],[ANCHOR=],[LINK=]),([FOOTNOTE=Steele SR, Brown TA, Rush RM, Martin MJ. Laparoscopic vs open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastrointest Surg. 2008 Mar;12(3):583-91.],[ANCHOR=],[LINK=]),([FOOTNOTE=da Luz Moreira A, Kiran RP, Kirat HT, et al. Laparoscopic versus open colectomy for patients with American Society of Anesthesiology (ASA) classifications 3 and 4: the minimally invasive approach is associated with significantly quicker recovery and reduced costs. Surg Endosc. 2010 Jun;24(6):1280-6.],[ANCHOR=],[LINK=]),([FOOTNOTE=Marshall CL, Chen GJ, Robinson CN, et al. Establishment of a minimally invasive surgery program leads to decreased inpatient cost of care in veterans with colon cancer. Am J Surg. 2010 Nov;200(5):632-5.],[ANCHOR=],[LINK=]),([FOOTNOTE=Eisenberg DP, Wey J, Bao PQ, et al. Short- and long-term costs of laparoscopic colectomy are significantly less than open colectomy. Surg Endosc. 2010 Sep;24(9):2128-34.],[ANCHOR=],[LINK=]),([FOOTNOTE=Vaid S, Tucker J, Bell T, Grim R, Ahuja V. Cost analysis of laparoscopic versus open colectomy in patients with colon cancer: results from a large nationwide population database. Am Surg. 2012 Jun;78(6):635-41.],[ANCHOR=],[LINK=])
In the UK, there was no significant difference in total hospital costs for open versus laparoscopic colorectal resection.([FOOTNOTE=Ding J, Xia Y, Liao GQ, et al. Hand-assisted laparoscopic surgery versus open surgery for colorectal disease: a systematic review and meta-analysis. Am J Surg. 2014 Jan;207(1):109-19.],[ANCHOR=],[LINK=])
In Canada, total costs were lower for laparoscopic colectomy than for open colectomy;2,([FOOTNOTE=Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005 Jul;6(7):477-84.],[ANCHOR=],[LINK=]) in one study this achieved statistical significance.2
Findings from Australia were inconsistent; in one study total costs were significantly lower with laparoscopic colectomy with than open colectomy([FOOTNOTE=Thompson BS, Coory MD, Gordon LG, Lumley JW. Cost savings for elective laparoscopic resection compared with open resection for colorectal cancer in a region of high uptake. Surg Endosc. 2014 May;28(5):1515-21.],[ANCHOR=],[LINK=]) and in another study they were not significantly higher.([FOOTNOTE=Jayne DG, Thorpe HC, Copeland J, et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010 Nov;97(11):1638-45.],[ANCHOR=],[LINK=])
Summary of meta-analysis comparing laparoscopic versus open colorectal surgery.
Summary of key clinical studies comparing laparoscopic versus open colorectal surgery.
Summary of key studies comparing economic outcomes of laparoscopic versus open colorectal surgery.