Cost-effectiveness Comparison of Manual Layered Anastomosis with Mechanical Stapling Technique in Esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHENGFeng-zhang , XUEJi-jun , ZHAOHai-long , ZHUXiao-kang ,  ZHUZi-jiang

Department of Thoracic Surgery, Gansu Tumor Hospital, Lanzhou 730050, P. R. China;

Corresponding author：

ZHUZi-jiang, Email: zhuzijiang2005@sina.com

Keywords：

Esophageal carcinoma; Manual layered anastomosis; Mechanical stapling technique; Cost-effectiveness analysis

DOI：

10.7507/1007-4848.20140142

Video：

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Objective To compare medical cost and utilization efficiency of medical resources between manual layered anastomosis with mechanical stapling technique in esophagectomy. Methods Clinical data of 132 patients who underwent surgical resection of esophageal carcinoma in the Department of Thoracic Surgery of Gansu Tumor Hospital between January and October 2011 were respectively analyzed. According to different anastomotic techniques, all the patients were divided into a manual layered anastomosis group (including 40 males and 20 females with their age of 36-72 (49.3±7.6) years) and a mechanical stapling technique group (including 50 males and 22 females with their age of 30-79 (51.0±8.6) years). Demographic data, operation data, postoperative complications, direct and indirect medical cost, and constitution of direct medical cost were compared between the 2 groups. Results Medical cost of esophagectomy was 14 505.03± 1 523.37 yuan in the manual layered anastomosis group and 19 891.05±1 634.58 yuan in the mechanical stapling technique group respectively, which were statistically different (P < 0.05). Material cost was 2 242.00±751.08 yuan in the manual layered anastomosis group and 5 424.00±1 876.22 yuan in the mechanical stapling technique group respectively, which were statistically different (P < 0.05). Cost-effectiveness analysis showed that cost-effectiveness ratio in the manual layered anastomosis group was lower, thus this anastomotic technique was more reasonable. Conclusion Medical cost of manual layered anastomosis is lower than that of mechanical stapling technique in esophagectomy, as the utilization efficiency of medical resources of manual layered anastomosis is higher than that of mechanical stapling technique.

Citation： ZHENGFeng-zhang, XUEJi-jun, ZHAOHai-long, ZHUXiao-kang, ZHUZi-jiang. Cost-effectiveness Comparison of Manual Layered Anastomosis with Mechanical Stapling Technique in Esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 503-506. doi: 10.7507/1007-4848.20140142 Copy

1.	Shimada H, Shiratori T, Okazumi S, et al. Have surgical outcomes of pathologic T4 esophageal squamous cell carcinoma really improved? Analysis of 268 cases during 45years of experience. J Am Coll Surg, 2008, 206 (1):48-56.
2.	Zhu ZJ, Zhao YF, Chen LQ, et al. Clinical application of layered anastomosis in esophagogastrostomy. World J Surg, 2008, 32 (4):583-588.
3.	王文凭, 陈龙奇.食管癌外科治疗新进展.中华临床医师杂志:电子版, 2009, 3 (11):1797-1803.
4.	郑鸿, 程永德, 李勇, 等.中晚期原发性肺癌介入治疗疗效和经济学分析.中国肿瘤, 2005, 14 (7):443-445.
5.	Janson M, Bjorhoh I, Carlsson P, et al. Randomized clinical trial of the costs of open and laparoscopic surgery forcolonic cancer.Br J Surg, 2004, 91 (4):409-417.
6.	Hartley JE, Mehigan BJ, Qureshi AE, et al. Total mesorectal excision:assessment of the laparoscopic approach. Dis Colon Rectum, 2001, 44 (3):315-321.
7.	Pikarsky AJ, Rosenthal R, Weiss EG, et al. Laparoscopictotal mesorectal excision.Surg Endosc, 2002, l6 (4):558-562.
8.	钟钏, 谭家驹, 徐致祥.食管癌流行病学病因学研究进展.河南预防医学, 2011, 22 (1):1-17.
9.	赫捷, 邵康.中国食管癌流行病学现状、诊疗现状及未来对策.中国癌症杂志, 2011, 21 (7):501-504.
10.	Martin LW, Hofstetter W, Swisher SG, et al. Management of intra thoracic leaks following esophag ectomy. Adv Surg, 2006, 40:173-190.
11.	史加海, 刘俊华.食管癌手术手工吻合与管状吻合器吻合的疗效比较.世界肿瘤杂志, 2005, 4 (3):196-197.
12.	蔡瑞君, 李梅, 熊刚, 等.机械吻合和手工吻合两种食管癌切除术的比较.南方医科大学学报, 2012, 32 (6):908-912.
13.	翁伟建, 司建荣, 雷道鑫, 等.吻合器机械吻合与手工吻合在食管贲门癌术后并发症的对比研究.局解手术学杂志, 2006, 15 (2):76-77.
14.	苏红凯, 周成运, 赵鹏, 等.食管癌切除颈部改良单层吻合术.中华胸心血管外科杂志, 2004, 20 (3):154.
15.	贡力, 方良伟, 田小丰, 等.胃代食管左颈部套入式吻合术治疗食管癌.实用临床医药杂志, 2009, 13 (6):53-54.
16.	陈名久, 吴显宁, 尹邦良, 等.可吸收线分层缝合法在颈部食管胃吻合术中的应用.中南大学学报:医学版, 2011, 36 (3):273-277.
17.	赵雍凡, 解晨昊, 王允, 等.食管胃分层吻合法的应用与实验观察.中国胸心血管外科临床杂志, 2005, 12 (3):164-168.
18.	任志, 李龙, 付茂勇.食管胃手工分层吻合术治疗食管癌、食管胃交界部癌的疗效观察.川北医学院学报, 2012, 27 (1):10-12.
19.	陈伦元, 任守阳, 王允, 等.食管胃手工分层吻合与机械吻合的成本效果分析.临床和实验医学杂志, 2008, 7 (7):5-6.
20.	权大荣, 夏时苍, 杨永太.食管胃分层吻合法与三叶钳应用预防吻合口并发症.四川医学, 2004, 25 (1):28.
21.	姚陈溉, 姚健, 官禹, 等.三叶钳分层吻合术在食管癌手术中的应用.四川医学, 2006, 27 (1):282-283.

1. Shimada H, Shiratori T, Okazumi S, et al. Have surgical outcomes of pathologic T4 esophageal squamous cell carcinoma really improved? Analysis of 268 cases during 45years of experience. J Am Coll Surg, 2008, 206 (1):48-56.
2. Zhu ZJ, Zhao YF, Chen LQ, et al. Clinical application of layered anastomosis in esophagogastrostomy. World J Surg, 2008, 32 (4):583-588.
3. 王文凭, 陈龙奇.食管癌外科治疗新进展.中华临床医师杂志:电子版, 2009, 3 (11):1797-1803.
4. 郑鸿, 程永德, 李勇, 等.中晚期原发性肺癌介入治疗疗效和经济学分析.中国肿瘤, 2005, 14 (7):443-445.
5. Janson M, Bjorhoh I, Carlsson P, et al. Randomized clinical trial of the costs of open and laparoscopic surgery forcolonic cancer.Br J Surg, 2004, 91 (4):409-417.
6. Hartley JE, Mehigan BJ, Qureshi AE, et al. Total mesorectal excision:assessment of the laparoscopic approach. Dis Colon Rectum, 2001, 44 (3):315-321.
7. Pikarsky AJ, Rosenthal R, Weiss EG, et al. Laparoscopictotal mesorectal excision.Surg Endosc, 2002, l6 (4):558-562.
8. 钟钏, 谭家驹, 徐致祥.食管癌流行病学病因学研究进展.河南预防医学, 2011, 22 (1):1-17.
9. 赫捷, 邵康.中国食管癌流行病学现状、诊疗现状及未来对策.中国癌症杂志, 2011, 21 (7):501-504.
10. Martin LW, Hofstetter W, Swisher SG, et al. Management of intra thoracic leaks following esophag ectomy. Adv Surg, 2006, 40:173-190.
11. 史加海, 刘俊华.食管癌手术手工吻合与管状吻合器吻合的疗效比较.世界肿瘤杂志, 2005, 4 (3):196-197.
12. 蔡瑞君, 李梅, 熊刚, 等.机械吻合和手工吻合两种食管癌切除术的比较.南方医科大学学报, 2012, 32 (6):908-912.
13. 翁伟建, 司建荣, 雷道鑫, 等.吻合器机械吻合与手工吻合在食管贲门癌术后并发症的对比研究.局解手术学杂志, 2006, 15 (2):76-77.
14. 苏红凯, 周成运, 赵鹏, 等.食管癌切除颈部改良单层吻合术.中华胸心血管外科杂志, 2004, 20 (3):154.
15. 贡力, 方良伟, 田小丰, 等.胃代食管左颈部套入式吻合术治疗食管癌.实用临床医药杂志, 2009, 13 (6):53-54.
16. 陈名久, 吴显宁, 尹邦良, 等.可吸收线分层缝合法在颈部食管胃吻合术中的应用.中南大学学报:医学版, 2011, 36 (3):273-277.
17. 赵雍凡, 解晨昊, 王允, 等.食管胃分层吻合法的应用与实验观察.中国胸心血管外科临床杂志, 2005, 12 (3):164-168.
18. 任志, 李龙, 付茂勇.食管胃手工分层吻合术治疗食管癌、食管胃交界部癌的疗效观察.川北医学院学报, 2012, 27 (1):10-12.
19. 陈伦元, 任守阳, 王允, 等.食管胃手工分层吻合与机械吻合的成本效果分析.临床和实验医学杂志, 2008, 7 (7):5-6.
20. 权大荣, 夏时苍, 杨永太.食管胃分层吻合法与三叶钳应用预防吻合口并发症.四川医学, 2004, 25 (1):28.
21. 姚陈溉, 姚健, 官禹, 等.三叶钳分层吻合术在食管癌手术中的应用.四川医学, 2006, 27 (1):282-283.

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Cost-effectiveness Comparison of Manual Layered Anastomosis with Mechanical Stapling Technique in Esophagectomy

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