OBJECTIVES:

Due to the increasing incidence rate of colorectal cancer worldwide, and its subsequent high medical care utilization, colorectal cancer has become one of the important health issues. In addition to traditional open surgery, laparoscopic surgery has gradually gain its popularity in treating colorectal patients in recent years. However, the impact of laparoscopic on clinical outcomes and medical cost has rarely been studied. Thus, the aims of this population-based study were to compare the clinical outcomes and medical costs between laparoscopic and open surgery for colon cancer patients from the perspective of National Health Insurance (NHI) in Taiwan.

METHODS:

This study used the 2010 Longitudinal Health Insurance Database which contains one million randomly chosen enrollees of the NHI. Incident patient received either laparoscopic or open surgery from 2007 to 2012 were first identified and included. Patients younger than 20 years old, had intestinal disease before receiving surgery were excluded. Propensity score matching (PSM) was conducted to reduce the heterogeneous imbalance between laparoscopic and open surgery group. The generalized estimating equation (GEE) and cox proportional hazards regression were performed to examine the differences in clinical outcomes and medical costs.

RESULTS:

There were 125 patients in each of the laparoscopic surgery and open surgery group after PSM. Colon cancer patients received laparoscopic surgery had significantly shorter length of stay (3.6 days; p <0.01). The overall 3-year survival (p =0.827) and recurrence-free 3-year survival (p =0.689) were similar between these two groups. For medical costs, laparoscopic surgery saved US$109 (p =0.63) for hospitalization due to surgery, US$177 (p <0.01) for ward costs, US$44 (p <0.01) for diagnosis costs, and US$386 (p =0.58) for total medical costs within 1 year.

CONCLUSIONS:

For colon cancer patients, laparoscopic surgery had better clinical outcomes and lower medical costs compared to open surgery.