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

Capozzi,Vito  Andrea; Sozzi,Giulio; Gambino,Giulia; Cianciolo,Alessandra; Riccò,Matteo; Monfardini,Luciano; Gaiano,Michela; Chiantera,Vito; Uccella,Stefano; Berretta,Roberto

doi:10.3892/mco.2019.1901

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
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Affiliations: Department of Gynecology and Obstetrics, University of Parma, I‑43125 Parma, Italy, Department of Gynecologic Oncology, University of Palermo, I-90127 Palermo, Italy, Department of Public Health, Workplace Prevention and Safety Service, AUSL1‑I.R.C.C.S. di Reggio Emilia, Service for Health and Safety on The Workplaces, I-42122 Reggio, Italy, Obstetrics and Gynecology Department, Ospedale degli Infermi, I‑13875 Biella, Italy
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.

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