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Cost savings for elective laparoscopic resection compared with open resection for colorectal cancer in a region of high uptake



Previous cost analyses of laparoscopic resection for colorectal cancer (CRC) reported slightly higher or similar costs to those of open resection. These analyses were based on randomised controlled trials when the laparoscopic approach was newly adopted. This study compared costs for laparoscopic versus open resection in a region of high uptake where adoption is mature.


Hospital cost data were obtained for elective resections for CRC that occurred between June 2009 and June 2011 in public hospitals in Queensland, Australia. The primary outcome was total cost and secondary outcomes were length-of-stay, operating time, and ICU admission. Multivariate least-squares regression was used to adjust for potential confounders: age, sex, comorbidities, procedure, and hospital volume.


The crude mean cost for laparoscopic resection was €20,036 compared with that for open resection of €22,780 (difference = €2,744). Patients who underwent laparoscopic resection (744/1,397; 53 %) were slightly younger and had fewer comorbidities (decreasing costs) but more had rectal surgery (increasing costs). The adjusted mean cost for laparoscopic resection was €20,396 compared with €22,442 for open resection (difference = €2,054). Compared with open resection, when adjusted for potential confounders, laparoscopic resection resulted in similar operating time (216 vs. 214 min), shorter length-of-stay (difference = −1.1 days, 95 % CI −1.9, −0.3), and shorter admission to ICU (difference = −7.3 h, 95 % CI −11.9, −2.7).


This non-randomised study in a region of high uptake found a similar operating time and lower cost for laparoscopic resection for CRC compared with those of open resection due to a shorter length-of-stay and shorter time in ICU. Laparoscopic resection for CRC saves money when the procedure is widely adopted and surgeons are experienced in the technique.

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  1. 1.

    Tjandra JJ, Chan MK (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 8:375–388

  2. 2.

    Noel JK, Fahrbach K, Estok R, Cella C, Frame D, Linz H, Cima RR, Dozois EJ, Senagore AJ (2007) Minimally invasive colorectal resection outcomes: short-term comparison with open procedures. J Am Coll Surg 204:291–307

  3. 3.

    Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819–824

  4. 4.

    Franks PJ, Bosanquet N, Thorpe H, Brown JM, Copeland J, Smith AM, Quirke P, Guillou PJ (2006) Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial). Br J Cancer 95:6–12

  5. 5.

    Hernandez RA, de Verteuil RM, Fraser CM, Vale LD (2008) Systematic review of economic evaluations of laparoscopic surgery for colorectal cancer. Colorectal Dis 10:859–868

  6. 6.

    Kapritsou M, Korkolis DP, Konstantinou EA (2013) Open or laparoscopic surgery for colorectal cancer: a retrospective comparative study. Gastroenterol Nurs 36:37–41

  7. 7.

    Norwood MG, Stephens JH, Hewett PJ (2011) The nursing and financial implications of laparoscopic colorectal surgery: data from a randomized controlled trial. Colorectal Dis 13:1303–1307

  8. 8.

    Dowson HM, Huang A, Soon Y, Gage H, Lovell DP, Rockall TA (2007) Systematic review of the costs of laparoscopic colorectal surgery. Dis Colon Rectum 50:908–919

  9. 9.

    Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238:67–72

  10. 10.

    Berto P, Lopatriello S, Aiello A, Corcione F, Spinoglio G, Trapani V, Melotti G (2012) Cost of laparoscopy and laparotomy in the surgical treatment of colorectal cancer. Surg Endosc 26:1444–1453

  11. 11.

    Buchanan GN, Cohen CR, Nicholls RJ (2004) Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer. Br J Surg 91:1202

  12. 12.

    Wilson CB (2006) Adoption of new surgical technology. Br Med J 332:112–114

  13. 13.

    Lumley J, Stitz R, Stevenson A, Fielding G, Luck A (2002) Laparoscopic colorectal surgery for cancer: intermediate to long-term outcomes. Dis Colon Rectum 45:867–872

  14. 14.

    Thompson BS, Coory MD, Lumley JW (2011) National trends in the uptake of laparoscopic resection for colorectal cancer, 2000-2008. Med J Aust 194:443–447

  15. 15.

    Kemp JA, Finlayson SR (2008) Nationwide trends in laparoscopic colectomy from 2000 to 2004. Surg Endosc 22:1181–1187

  16. 16.

    Rea JD, Cone MM, Diggs BS, Deveney KE, Lu KC, Herzig DO (2011) Utilization of laparoscopic colectomy in the United States before and after the clinical outcomes of surgical therapy study group trial. Ann Surg 254:281–288

  17. 17.

    National Institute for Health and Clinical Excellence (2010) Review of NICE technology appraisal guidance No 105: laparoscopic surgery for the treatment of colorectal cancer. Available at: Accessed 2 Apr 2013

  18. 18.

    Hall RM, Linklater N, Coughlin G (2013) Robotic and open radical prostatectomy in the public health sector: cost comparison. ANZ J Surg. doi:10.1111/ans.12097

  19. 19.

    Reserve Bank of Australia. Inflation Calculator. Available at: Accessed 2 Apr 2013

  20. 20.

    XE Currency Converter. Available at: Accessed 2 Apr 2013

  21. 21.

    White H (1980) A heteroskedasticity-consistent covariance matrix and a direct test for heteroskedasticity. Econometrica 48:817–838

  22. 22.

    Lumley T, Diehr P, Emerson S, Chen L (2002) The importance of the normality assumption in large public health data sets. Annu Rev Public Health 23:151–169

  23. 23.

    Hunter DR, Lange K (2000) Quantile regression via an MM algorithm. J Comput Graph Stat 9:60–77

  24. 24.

    National Institute for Health and Clinical Excellence (2000) Laparoscopic surgery for colorectal cancer (review). Review of NICE technology appraisal 17. Available at: Accessed 2 Apr 2013

  25. 25.

    UK inflation (CPI) calculator. Available at: Accessed 2 Apr 2013

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While conducting this research, the lead author received salary support from the Patient Safety and Quality Improvement Service, Queensland Health, and a PhD Scholarship from the Australian Centre for Health Services Innovation (AusHSI). The authors express their gratitude to Colin Roberts, Business Intelligence Officer, Queensland Health, for extracting the data required for this study and for sharing his invaluable knowledge of the data sources.


Bridie Thompson and Drs. Coory, Gordon, and Lumley have no conflicts of interest or financial ties to disclose.

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Correspondence to Bridie S. Thompson.

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Thompson, B.S., Coory, M.D., Gordon, L.G. et al. Cost savings for elective laparoscopic resection compared with open resection for colorectal cancer in a region of high uptake. Surg Endosc 28, 1515–1521 (2014).

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  • Colorectal cancer
  • Laparoscopic resection
  • Cost comparison
  • Population-based data