Clinical and economic effects of the transformation from an open to a laparoscopic center for colorectal surgery

Langenbecks Arch Surg. 2025 Jan 15;410(1):38. doi: 10.1007/s00423-024-03590-8.

Abstract

Purpose: The purpose of this study was to assess the feasibility of transitioning from open to laparoscopic surgery for colorectal carcinoma in a primary care hospital setting. Despite the recognized benefits of laparoscopic surgery in postoperative recovery and its demonstrated oncological equivalence, only a minority of patients (30-40%) in Germany undergo laparoscopic procedures, primarily due to concerns which, in addition to the perioperative quality data and economic aspects, focus on patient safety.

Methods: Over a three-year period (2012-2014), the transformation process was observed in a colorectal cancer center. Data from 237 patients (115 laparoscopic; 122 open) were collected prospectively and analyzed retrospectively. Short-term outcomes, including demographic data, perioperative complications, and quality metrics, as well as long-term survival data, were included.

Results: Laparoscopic surgery demonstrated several advantages. Postoperative intensive care needs decreased significantly (average length of stay: laparoscopic 1.2 days vs. open 2.5 days; p = 0.032). Hospital stays were also shorter following laparoscopic surgery (median laparoscopic 10 days vs. median open 14 days; p = 0.011). Quality of specimens, particularly lymph node retrieval, remained comparable (median laparoscopic = 18 vs. median open = 19). Survival data showed non- inferiority of the laparoscopic approach. Despite higher initial costs, laparoscopic surgery yielded cost savings of approximately 3150 € per case due to reduced intensive care and shorter hospital stays.

Conclusion: In conclusion, this study demonstrates the feasibility of transitioning from open to laparoscopic oncologic colorectal surgery in a primary care hospital setting. The findings suggest that such a transition can be accomplished without compromising the quality of specimens, while also realizing cost savings and maintaining patient safety.

Keywords: Colorectal carcinoma; Colorectal surgery; Laparoscopy; Open surgery; Transition.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Colectomy / adverse effects
  • Colectomy / economics
  • Colorectal Neoplasms* / economics
  • Colorectal Neoplasms* / surgery
  • Feasibility Studies
  • Female
  • Germany
  • Humans
  • Laparoscopy* / adverse effects
  • Laparoscopy* / economics
  • Length of Stay / economics
  • Male
  • Middle Aged
  • Postoperative Complications / economics
  • Retrospective Studies
  • Treatment Outcome