Cost analysis of laparoscopic total versus open total gastrectomy in gastric cancer

Abstract

Purpose: Despite ongoing discussions concerning clinical equivalence of laparoscopic total gastrectomy (LTG) compared to open total gastrectomy (OTG) in gastric cancer (GC) surgery, complementary evidence regarding financial implications is sparse. The aim of this study was to compare hospital associated expenses and perioperative outcomes between both approaches. Methods: Clinicopathological and financial data from 80 consecutive GC patients undergoing LTG or OTG between 2015 and 2022 were investigated. Patient baseline characteristics, perioperative results, long-term outcomes and financial expenses up to 30 days after discharge were compared. A binary logistic regression model to identify individual cost drivers was performed. Results: LTG was associated with significantly prolonged operating time (281 min vs. 245 min, p < 0.02). However, LTG demonstrated a trend towards lower total (18,708 € vs. 22,810 €, p = 0.11) and median daily (1,516 € vs. 1,721 €, p = 0.25) expenses, yet not reaching statistical significance. Decreased ICU costs emerged as the greatest single cost reducer in LTG (962 € vs. 2,147 €, p = 0.10). Hospital length of stay ≥ 15 days was the only independent cost driver for increased expenses (HR [95% CI] = 13,2 [3.0-58.9], p < 0.01). Ultimately, patients undergoing LTG and OTG demonstrated similar outcomes in terms of perioperative morbidity (n = 8, 13% vs. n = 3, 17%, p = 0.70), median number of resected lymph nodes (n = 32 vs. n = 33, p = 0.72), absence of 90-day mortality, and long-term survival (p = 0.47). Conclusion: Although typically involving longer operating times, LTG tends to be linked with decreased hospital costs, yet not reaching statistical significance. The ongoing establishment of LTG seems not to pose additional financial burdens for surgical departments.