Open Access

Laparoscopy versus laparotomy for surgical treatment of obese women with endometrial cancer: A cost‑benefit comparative analysis

  • Authors:
    • Vito Andrea Capozzi
    • Giulio Sozzi
    • Giulia Gambino
    • Alessandra Cianciolo
    • Matteo Riccò
    • Luciano Monfardini
    • Michela Gaiano
    • Vito Chiantera
    • Stefano Uccella
    • Roberto Berretta
  • View Affiliations

  • Published online on: July 22, 2019     https://doi.org/10.3892/mco.2019.1901
  • Pages: 335-342
  • Copyright: © Capozzi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The aim of the present study was to demonstrate the cost of obese patients affected by endometrial cancer undergoing open surgery compared with minimally invasive surgery. In the retrospective cohort study (Canadian Task Force classification II‑2), the economic expenditure in pre‑operative, intra‑operative and post‑operative phases of the selected patients was evaluated. Costs were analyzed for all blood tests, instrumental examinations, consultations, operating materials, drugs, gynecological examinations, hospital stay, intensive care hospitalization and management of operative complications. The average length of stay was longer for patients who underwent laparotomy, with an almost double median hospitalization cost in the open abdominal group compared with the laparoscopic group (€4,805.37 vs. €2,589.25; P<0.0001). Evaluation by another specialist (cardiologist, diabetologist, internist) was necessary in 30.9% of laparotomies vs. 10.4% of laparoscopies (P=0.003). A respiratory support was applied to 38 patients (28.8%), of whom 23 (41.8%) were in the open abdominal arm (P=0.011). Antibiotic and pain‑relief therapies resulted in a significantly higher cost for the open abdominal than for the minimally‑invasive approach (P=0.027). Considering all the pre‑, intra‑ and post‑operative course, the expenses for an obese patient operated by laparoscopy was €4,412.41 vs. €7,323.17 by open surgery, with an average saving of €2,911.03 in favor of minimally‑invasive surgery. This study revealed that in obese patients with endometrial cancer, minimally invasive surgery is more advantageous both in terms of costs and post‑operative complications. To conclude, laparoscopic surgery in obese patients allows an economic saving of ~60% less than open surgery.

References

1 

NCD Risk Factor Collaboration (NCD-RisC), . Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents and adults. Lancet. 390:2627–2642. 2017. View Article : Google Scholar : PubMed/NCBI

2 

Wold Health Organization: WHO Regional Office for Europe and the Directorate-General for Health and Consumers of the European Commission. Methodology and summary. World Health Organization; Copenhagen: 2013

3 

Osservasalute Report: State of health and quality of assistance in the Italian regions, 2016. simplehttps://www.osservatoriosullasalute.it/wp-content/uploads/2017/05/ro-2016.pdfSeptember 5–2018

4 

Arterburn DE, Maciejewski ML and Tsevat J: Impact of morbid obesity on medical expenditures in adults. Int J Obes (Lond). 29:334–339. 2005. View Article : Google Scholar : PubMed/NCBI

5 

Uccella S, Bonzini M, Palomba S, Fanfani F, Ceccaroni M, Seracchioli R, Vizza E, Ferrero A, Roviglione G, Casadio P, et al: Impact of obesity on surgical treatment for endometrial cancer: A multicenter study comparing laparoscopy vs. open surgery, with propensity-matched analysis. J Minim Invasive Gynecol. 23:53–61. 2016. View Article : Google Scholar : PubMed/NCBI

6 

Obermair A, Brennan DJ, Baxter E, Armes JE, Gebski V and Janda M: Surgical safety and personal costs in morbidly obese, multimorbid patients diagnosed with early-stage endometrial cancer having a hysterectomy. Gynecol Oncol Res Pract. 3:12016. View Article : Google Scholar : PubMed/NCBI

7 

Sankaranarayanan R and Ferlay J: Worldwide burden of gynaecological cancer: The size of the problem. Best Pract Res Clin Obstet Gynaecol. 20:207–225. 2006. View Article : Google Scholar : PubMed/NCBI

8 

Siegel R, Ma J and Jemal A: Cancer statistics, 2014. CA Cancer J Clin. 64:9–29. 2014. View Article : Google Scholar : PubMed/NCBI

9 

Ghezzi F, Cromi A, Uccella S, Siesto G, Zefiro F and Bolis P: Incorporating laparoscopy in the practice of a gynecologic oncology service: Actual impact beyond clinical trials data. Ann Surg Oncol. 16:2305–2314. 2009. View Article : Google Scholar : PubMed/NCBI

10 

Gueli Alletti S, Rossitto C, Cianci S, Restaino S, Costantini B, Fanfani F, Fagotti A, Cosentino F and Scambia G: Telelap ALF-X vs. standard laparoscopy for the treatment of early-stage endometrial cancer: A single-institution retrospective cohort study. J Minim Invasive Gynecol. 23:378–383. 2016. View Article : Google Scholar : PubMed/NCBI

11 

Rossitto C, Gueli Alletti S, Rotolo S, Cianci S, Panico G and Scambia G: Total laparoscopic hysterectomy using a percutaneous surgical system: A pilot study towards scarless surgery. Eur J Obstet Gynecol Gynecol Reprod Biol. 203:132–135. 2016. View Article : Google Scholar

12 

Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, Spiegel G, Barakat R, Pearl ML and Sharma SK: Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic oncology group study LAP2. J Clin Oncol. 27:5331–5336. 2009. View Article : Google Scholar : PubMed/NCBI

13 

Gehrig PA, Cantrell LA, Shafer A, Abaid LN, Mendivil A and Boggess JF: What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman. Gynecol Oncol. 111:41–45. 2008. View Article : Google Scholar : PubMed/NCBI

14 

Uccella S, Cromi A, Bogani G, Casarin J, Formenti G and Ghezzi F: Systematic implementation of laparoscopic hysterectomy independent of uterus size: Clinical effect. J Minim Invasive Gynecol. 20:505–516. 2013. View Article : Google Scholar : PubMed/NCBI

15 

Onstad MA, Schmandt RE and Lu KH: Addressing the role of obesity in endometrial cancer risk prevention and treatment. J Clin Oncol. 34:4225–4230. 2016. View Article : Google Scholar : PubMed/NCBI

16 

Eltabbakh GH, Shamonki MI, Moody JM and Garafano LL: Hysterectomy for obese women with endometrial cancer: Laparoscopy or laparotomy. Gynecol Oncol. 78:329–335. 2000. View Article : Google Scholar : PubMed/NCBI

17 

Scribner DR Jr, Walker JL, Johnson GA, McMeekin DS, Gold MA and Mannel RS: Laparoscopic pelvic and paraaortic lymph node dissection in the obese. Gynecol Oncol. 84:426–430. 2002. View Article : Google Scholar : PubMed/NCBI

18 

Elsahwi KS, Hooper C, De Leon MC, Gallo TN, Ratner E, Silasi DA, Santin AD, Schwartz PE, Rutherford TJ and Azodi M: Comparison between 155 cases of robotic vs. 150 cases of open surgical staging for endometrial cancer. Gynecol Oncolc. 124:260–264. 2012. View Article : Google Scholar

19 

Lu Z, Yi X, Feng W, Ding J, Xu H, Zhou X and Hua K: Cost-benefit analysis of laparoscopic surgery versus laparotomy for patients with endometrioid endometrial cancer: Experience from an institute in China. J Obstet Gynaecol Res. 38:1011–1017. 2012. View Article : Google Scholar : PubMed/NCBI

20 

Spirtos NM, Schlaerth JB, Gross GM, Spirtos TW, Schlaerth AC and Ballon SC: Cost and quality-of-life analyses of surgery for early endometrial cancer: Laparotomy versus laparoscopy. Am J Obstet Gynecol. 174:1795–1800. 1996. View Article : Google Scholar : PubMed/NCBI

21 

Bell MC, Torgerson J, Seshadri-kreaden U, Wierda A and Hunt S: Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy standard laparoscopy and robotic techniques. Gynecol Oncol. 111:407–411. 2008. View Article : Google Scholar : PubMed/NCBI

22 

Bijen CB, Vermeulen KM, Mourits MJ, Arts HJ, Ter Brugge HG, van der Sijde R, Wijma J, Bongers MY, van der Zee AG and de Bock GH: Cost effectiveness of laparoscopy versus laparotomy in early stage endometrial cancer: A randomised trial. Gynecol Oncol. 121:76–82. 2011. View Article : Google Scholar : PubMed/NCBI

23 

World Health Organization, . Obesity: Preventing and managing the global epidemic. Report of a WHO Consultation on Obesity Geneva: June 3-5–1997, simplehttps://apps.who.int/iris/handle/10665/63854September 5–2018

24 

National Heart, Lung, and Blood Institute, . Obesity Education Initiative Expert Panel on the identification, Evaluation, and Treatment of Obesity in Adults at High Risk for Cardiovascular Disease. Clinical Guidelines on the Identification Evaluation, and Treatment of Overweight and Obesity in Adults. National Heart Lung and Blood Institute (ed.). National Institutes of Health; Bethesda MD: 1998

25 

Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR, et al: ESMO-ESGO-ESTRO Consensus conference on endometrial cancer: Diagnosis treatment and Follow-up. Int J Gynecol Cancer. 27:16–41. 2016.

26 

Querleu D and Morrow CP: Classification of radical hysterectomy. Lancet Oncol. 9:297–303. 2008. View Article : Google Scholar : PubMed/NCBI

27 

Uccella S, Bonzini M, Malzoni M, Fanfani F, Palomba S, Aletti G, Corrado G, Ceccaroni M, Seracchioli R, Shakir F, et al: The effect of a uterine manipulator on the recurrence and mortality of endometrial cancer: A multi-centric study by the Italian society of gynecological endoscopy. Am J Obstet Gynecol. 216:592.e1–592.e11. 2017. View Article : Google Scholar

28 

Chassagne D, Sismondi P, Horiot JC, Sinistrero G, Bey P, Zola P, Pernot M, Gerbaulet A, Kunkler I and Michel G: A glossary for reporting complications of treatment in gynecological cancers. Radiother Oncol. 26:195–202. 1993. View Article : Google Scholar : PubMed/NCBI

29 

Suidan RS, He W, Sun CC, Zhao H, Fleming ND, Ramirez PT, Soliman PT, Westin SN, Lu KH, Giordano SH and Meyer LA: Impact of body mass index and operative approach on surgical morbidity and costs in women with endometrial carcinoma and hyperplasia. Gynecol Oncol. 145:55–60. 2017. View Article : Google Scholar : PubMed/NCBI

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Copy and paste a formatted citation
APA
Capozzi, V.A., Sozzi, G., Gambino, G., Cianciolo, A., Riccò, M., Monfardini, L. ... Berretta, R. (2019). Laparoscopy versus laparotomy for surgical treatment of obese women with endometrial cancer: A cost‑benefit comparative analysis. Molecular and Clinical Oncology, 11, 335-342. https://doi.org/10.3892/mco.2019.1901
MLA
Capozzi, V. A., Sozzi, G., Gambino, G., Cianciolo, A., Riccò, M., Monfardini, L., Gaiano, M., Chiantera, V., Uccella, S., Berretta, R."Laparoscopy versus laparotomy for surgical treatment of obese women with endometrial cancer: A cost‑benefit comparative analysis". Molecular and Clinical Oncology 11.4 (2019): 335-342.
Chicago
Capozzi, V. A., Sozzi, G., Gambino, G., Cianciolo, A., Riccò, M., Monfardini, L., Gaiano, M., Chiantera, V., Uccella, S., Berretta, R."Laparoscopy versus laparotomy for surgical treatment of obese women with endometrial cancer: A cost‑benefit comparative analysis". Molecular and Clinical Oncology 11, no. 4 (2019): 335-342. https://doi.org/10.3892/mco.2019.1901