Optimizing clinical and economic outcomes of surgical therapy for patients with colorectal cancer and synchronous liver metastases
Journal of the American College of Surgeons,

Abbott DE et al. – The simultaneous resection strategy was oncologically equivalent and more cost efficient for patients with primary colorectal cancer presenting with resectable liver metastases. A reduction in overall length of hospital stay was an associated benefit. Future studies should explore the feasibility and clinical implications of policies to maximize the potential for simultaneous resection in this cohort of patients.

Methods
  • Authors conducted a retrospective cohort study of consecutive colorectal cancer patients with resectable synchronous liver metastases treated between 1993 and 2010, constructing a decision tree comparing simultaneous and staged resections.
  • For generalizability, the analysis was conducted from a payer perspective, using costs derived from 2010 Medicare reimbursement.
  • Decision models incorporated the severity–refined DRG complications (complicating condition/major complicating condition) modifiers.
  • Sensitivity analyses used alternative models of DRG reimbursement.

Results
  • There were 144 patients analyzed. Sixty (41.7%) underwent simultaneous resection and 84 (58.3%) underwent staged resection.
  • Median overall survival did not differ between the simultaneous and the staged cohorts (66.3 vs 65.6 months, respectively), nor did the overall complication rate (38.3% vs 40.5%, respectively).
  • Median total length of hospitalization was significantly shorter in the simultaneous cohort (8 vs 14 days; p = 0.001).
  • In the base model, the simultaneous strategy cost less than the staged strategy ($20,983 vs $25,298 per case)—a savings of 17.1%.
  • Sensitivity analyses examining alternative severity–refined DRG reimbursements demonstrated potential cost savings, in all but 1 extreme sensitivity analysis, ranging from 9.8% to 27.3% favoring simultaneous resection.

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Surgery

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Surgery Articles

1 Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: A single center experience with 2 years follow-up Obesity Surgery, August 8, 2014    Clinical Article

2 Long intestinal tube splinting really prevent recurrence of postoperative adhesive small bowel obstruction? A study of 1071 cases The American Journal of Surgery, July 23, 2014    Clinical Article

3 Metabolic effects of large-volume liposuction for obese healthy women: A meta-analysis of fasting insulin levels Aesthetic Plastic Surgery, August 19, 2014    Evidence Based Medicine    Review Article

4 Single-anastomosis gastric bypass (SAGB): appraisal of clinical evidence Obesity Surgery, August 4, 2014    Evidence Based Medicine

5 Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. A prospective study with 5 years of follow-up Obesity Surgery, July 14, 2014    Clinical Article

6 Comparison of marginal ulcer rates between antecolic and retrocolic laparoscopic Roux-en-Y gastric bypass Obesity Surgery, August 7, 2014    Clinical Article

7 The effect of PPI use on human gut microbiota and weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass Obesity Surgery, August 13, 2014    Clinical Article

8 Abdominoplasty-derived dermal-fat graft augmentation gluteoplasty Aesthetic Surgery Journal, August 25, 2014    Review Article
Exclusive Author Commentary

9 Complications of bariatric surgery: Dumping syndrome, reflux and vitamin deficiencies Best Practice & Research Clinical Gastroenterology , August 1, 2014    Clinical Article

10 Bariatric surgery in elderly patients. A comparison between gastric banding and sleeve gastrectomy with five years of follow up International Journal of Surgery, August 26, 2014    Clinical Article

11 Short- and long-term outcomes of LigaSure versus conventional surgery for curative gastric cancer resection: a matched pair analysis Gastric Cancer, August 22, 2014    Clinical Article

12 Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction The Journal of Trauma and Acute Care Surgery, June 9, 2014    Evidence Based Medicine    Clinical Article

13 Gastrogastric fistulae following gastric bypass surgery-clinical recognition and treatment Current Gastroenterology Reports, August 20, 2014    Clinical Article

14 DermACELL: a novel and biocompatible acellular dermal matrix in tissue expander and implant-based breast reconstruction European Journal of Plastic Surgery, August 14, 2014    Clinical Article

15 Laparoscopic versus robotic Roux-en-Y gastric bypass: Lessons and long-term follow-up learned from a large prospective monocentric study Obesity Surgery, July 1, 2014    Clinical Article

16 Correlation between the gastrojejunostomosis area, documented endoscopically, and the loss of weight in laparoscopic gastric bypass postoperative patients: Results of 1 year after surgery Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, August 11, 2014    Clinical Article

17 Laparoscopic versus open low anterior resection for rectal cancer: results from the National Cancer Data Base Journal of Gastrointestinal Surgery, August 11, 2014    Clinical Article

18 Primary sleeve gastrectomy compared to sleeve gastrectomy as revisional surgery: weight loss and complications at intermediate follow-up Journal of Gastrointestinal Surgery, August 15, 2014    Review Article

19 Closed-tube thoracostomy: A novel emergency surgery technique Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, August 20, 2014    Clinical Article

20 Two stages conversion of failed laparoscopic adjustable gastric banding to laparoscopic Roux-en-Y gastric bypass. A study of one hundred patients Journal of Gastrointestinal Surgery, August 6, 2014    Clinical Article

Indexed Journals in Surgery: Surgery, Journal of the American College of Surgeons, Annals of Surgerymore

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close