Conor P Delaney

Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

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Publications (258)1027.48 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The most common sites of colorectal cancer (CRC) recurrence are the local tissues, liver or lungs. The objective was to identify risk factors associated with the primary CRC tumor and cancer recurrence in these anatomical sites. Retrospective, longitudinal analyses of data on CRC survivors. Multivariable Cox regression analysis was performed to examine the association between possible cofounders with recurrence to various anatomical sites. Data for 10,398CRC survivors (tumor location right colon=3870, left colon=2898, high rectum=2569, low rectum=1061) were analyzed; follow up time was up to five years. Mean age at curative surgery was 71.5 (SD 11.8) years, 20.2% received radio-chemotherapy, stage T3 (64.4%) and N0 (65.1%) were most common. Overall 1632 (15.7%) had cancer recurrence (Isolated liver n=412, 3,8%; isolated lung n=252, 2,4%; isolated local n=223, 2.1%). Risk factors associated with recurrent CRC were identified, i.e. isolated liver metastases (male: Adjusted Hazard Ratio (AHR) 1,45; colon left: AHR 1,63; N2 disease: AHR 3,35; T2 disease: AHR 2,82), isolated lung metastases (colon left: AHR 1,53; rectum high: AHR 2,48; rectum low: AHR 2,65; N2 disease 3,76), and local recurrence (glands examined<12: AHR 1,51; CRM <3mm: AHR 1,60; rectum high: AHR 2,15; N2 disease: AHR 2,58) (all p values <0001). Our study finds that the site of the primary CRC tumor is associated with location of subsequent metastasis. Left sided colon cancers have increased risk of metastatic spread to the liver, whereas rectal cancers have increased risk of local recurrence and metastatic spread to the lungs. These results, in combination with other risk factors for CRC recurrence, should be taken into consideration when designing risk adapted post-treatment CRC surveillance programs. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
    08/2015; DOI:10.1016/j.canep.2015.07.009
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    ABSTRACT: We report our initial clinical experience from a pilot study to compare the diagnostic accuracy of hybrid PET/MRI with PET/CT in colorectal cancer and discuss potential PET/MRI workflow solutions for colorectal cancer. Patients underwent both FDG PET/CT and PET/MRI (Ingenuity TF PET/MRI, Philips Healthcare) for rectal cancer staging or colorectal cancer restaging. The PET acquisition of PET/MRI was similar to that of PET/CT whereas the MRI protocol was selected individually based on the patient's medical history. One nuclear medicine physician reviewed the PET/CT studies and one radiologist reviewed the PET/MRI studies independently. The diagnostic accuracy of each modality was determined in consensus, using available medical records as a reference. Of the 12 patients enrolled, two were for initial staging and ten for restaging. The median scan delay between the two modalities was 60 min. The initial imaging was PET/CT in nine patients and PET/MRI in three patients. When PET/CT was performed first, the SUV values of the 16 FDG avid lesions were greater at PET/MRI than at PET/CT. In contrast, when PET/MRI was performed first, the SUV values of the seven FDG avid lesions were greater at PET/CT than at PET/MRI. PET/MRI provided more detailed T staging than PET/CT. On a per-patient basis, with both patient groups combined for the evaluation of N and M staging/restaging, the true positive rate was 5/7 (71%) for PET/CT and 6/7 (86%) for PET/MRI, and true negative rate was 5/5 (100%) for both modalities. On a per-lesion basis, PET/CT identified 26 of 29 (90%) tumor lesions that were correctly detected by PET/MRI. Our proposed workflow allows for comprehensive cancer staging including integrated local and whole-body assessment. Our initial experience shows a high diagnostic accuracy of PET/MRI in T staging of rectal cancer compared with PET/CT. In addition, PET/MRI shows at least comparable accuracy in N and M staging as well as restaging to PET/CT. However, the small sample size limits the generalizability of the results. It is expected that PET/MRI would yield higher diagnostic accuracy than PET/CT considering the high soft tissue contrast provided by MRI compared with CT, but larger studies are necessary to fully assess the benefit of PET/MRI in colorectal cancer.
    Abdominal Imaging 06/2015; DOI:10.1007/s00261-015-0474-0 · 1.73 Impact Factor
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    ABSTRACT: Laparoscopic colectomy is safe and effective in the treatment of many colorectal diseases. However, the effect of increasing use of laparoscopy on overall health care utilization and costs, especially in the long term, has not been thoroughly investigated. To evaluate the effect of laparoscopic vs open colectomy on short- and long-term health care utilization and costs. Retrospective multivariate regression analysis of national health insurance claims data was used to evaluate health care utilization and costs up to 1 year following elective colectomy. Data were obtained from the Truven Health Analytics MarketScan Commercial Claims and Encounters database. Patients aged 18 to 64 years who underwent elective laparoscopic or open colectomy from January 1, 2010, through December 31, 2010, were included. Patients with complex diagnoses that require increased non-surgery-related health care utilization, including malignant neoplasm, inflammatory bowel disease, human immunodeficiency virus, transplantation, and pregnancy, were excluded. Of 25 481 patients who underwent colectomy, 4160 were included in the study. Healthcare utilization, including office, hospital outpatient, and emergency department visits and inpatient services 90 and 365 days after the index procedure; total health care costs; and estimated days off from work owing to health care utilization. Of 25 481 patients who underwent colectomy, 4160 were included in the study (laparoscopic, 45.6%; open, 54.4%). The mean (SD) net and total payments were lower for laparoscopy ($23 064 [$14 558] and $24 196 [$14 507] vs $29 753 [$21 421] and $31 606 [$23 586]). In the first 90 days after surgery, an open approach was significantly associated with a 1.26-fold increase in health care costs (estimated, $1715; 95% CI, $338-$2853), increased use of heath care services, and more estimated days off from work (2.78 days; 95% CI, 1.93-3.59). Similar trends were found in the full postoperative year, with an estimated 1.18-fold increase (95% CI, 1.04-1.35) in health care expenditures and an increase of 1.15 times (95% CI, 1.08-1.23) the number of health care utilization days compared with laparoscopy. Laparoscopic colectomy results in a significant reduction in health care costs and utilization in the short- and long-term postoperative periods.
    JAMA SURGERY 03/2015; 150(5). DOI:10.1001/jamasurg.2014.3171 · 4.30 Impact Factor
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    ABSTRACT: Study Shows Patients Who Underwent Laparoscopic Colon Resections Left Hospital Faster, Required Significantly Less Follow Up Care and Fewer Medicines Than Patients Who Underwent Open Surgery DUBLIN-March 25, 2015-Adding to the clinical benefits and improved patient outcomes associated with minimally-invasive surgery (MIS), Medtronic plc (NYSE: MDT) today highlighted new data demonstrating that patients who underwent minimally invasive colon resection procedures were able to leave the hospital faster, visit their doctors less for follow up care and take fewer medicines 1 than those who underwent open surgery. The findings, which were published in the March 25 online edition of JAMA Surgery, suggest that minimally invasive approaches offer compelling near-and long-term cost savings for the healthcare system and less trauma for patients. "We found that the use of minimally-invasive laparoscopic approaches in a select group of patients undergoing colectomy procedures resulted in significantly lower health care costs and resource utilization compared with open surgical approaches. This may expand access and lower the cost of patient care in the long term," said lead author Conor P. Delaney, MD PhD, of University Hospitals Case Medical Center in Cleveland, Ohio. "These results reflect the well-documented benefits of laparoscopic surgery, which include faster recovery, less pain and fewer complications." A colectomy is the surgical removal of part or all of the colon and the rectum and is usually performed to treat several digestive health conditions, including diverticulitis, Crohn's disease, ulcerative colitis and cancer of the colon and rectum.
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    ABSTRACT: Unexpected variations in postoperative length of stay (LOS) negatively impact resources and patient outcomes. Statistical process control (SPC) measures performance, evaluates productivity, and modifies processes for optimal performance. The goal of this study was to initiate SPC to identify LOS outliers and evaluate its feasibility to improve outcomes in colorectal surgery. Review of a prospective database identified colorectal procedures performed by a single surgeon. Patients were grouped into elective and emergent categories and then stratified by laparoscopic and open approaches. All followed a standardized enhanced recovery protocol. SPC was applied to identify outliers and evaluate causes within each group. A total of 1294 cases were analyzed-83 % elective (n = 1074) and 17 % emergent (n = 220). Emergent cases were 70.5 % open and 29.5 % laparoscopic; elective cases were 36.8 % open and 63.2 % laparoscopic. All groups had a wide range in LOS. LOS outliers ranged from 8.6 % (elective laparoscopic) to 10.8 % (emergent laparoscopic). Evaluation of outliers demonstrated patient characteristics of higher ASA scores, longer operating times, ICU requirement, and temporary nursing at discharge. Outliers had higher postoperative complication rates in elective open (57.1 vs. 20.0 %) and elective lap groups (77.6 vs. 26.1 %). Outliers also had higher readmission rates for emergent open (11.4 vs. 5.4 %), emergent lap (14.3 vs. 9.2 %), and elective lap (32.8 vs. 6.9 %). Elective open outliers did not follow trends of longer LOS or higher reoperation rates. SPC is feasible and promising for improving colorectal surgery outcomes. SPC identified patient and process characteristics associated with increased LOS. SPC may allow real-time outlier identification, during quality improvement efforts, and reevaluation of outcomes after introducing process change. SPC has clinical implications for improving patient outcomes and resource utilization.
    Surgical Endoscopy 02/2015; DOI:10.1007/s00464-015-4108-y · 3.31 Impact Factor
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    ABSTRACT: High-resolution anoscopy has been shown to improve identification of anal intraepithelial neoplasia but a reduction in progression to anal squamous-cell cancer has not been substantiated when serial high-resolution anoscopy is compared with traditional expectant management. The aim of this study was to compare high-resolution anoscopy versus expectant management for the surveillance of anal intraepithelial neoplasia and the prevention of anal cancer. This is a retrospective review of all patients who presented with anal squamous dysplasia, positive anal Pap smears, or anal squamous-cell cancer from 2007 to 2013. This study was performed in the colorectal department of a university-affiliated, tertiary care hospital. Included patients had biopsy-proven anal intraepithelial neoplasia from 2007 to 2013. Patients were treated with high-resolution anoscopy with ablation or standard anoscopy with ablation. Both groups were treated with imiquimod and followed every 6 months indefinitely. The incidence of anal squamous-cell cancer in each group was the primary end point. From 2007 to 2013, 424 patients with anal squamous dysplasia were seen in the clinic (high-resolution anoscopy, 220; expectant management, 204). Three patients (high-resolution anoscopy, 1; expectant management, 2) progressed to anal squamous-cell cancer; 2 were noncompliant with follow-up and with HIV treatment, and the third was allergic to imiquimod and refused to take topical 5-fluorouracil. The 5-year progression rate was 6.0% (95% CI, 1.5-24.6) for expectant management and 4.5% (95% CI, 0.7-30.8) for high-resolution anoscopy (p = 0.37). This was a retrospective review. There is potential for selection and referral bias. Because of the rarity of the outcome, the study may be underpowered. Patients with squamous-cell dysplasia followed with expectant management or high-resolution anoscopy rarely develop squamous-cell cancer if they are compliant with the protocol. The cost, morbidity, and value of high-resolution anoscopy should be further evaluated in lieu of these findings.
    Diseases of the Colon & Rectum 01/2015; 58(1):53-9. DOI:10.1097/DCR.0000000000000267 · 3.20 Impact Factor
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    ABSTRACT: Early discharge following colorectal surgery has become more frequent with increased use of laparoscopy and enhanced recovery pathways (ERP). Discharge within 48 hours of surgery is not routinely achieved, and concerns remain over the safety of such early discharge. We analyzed colectomy patients to identify factors that may lend to expedited recovery, and demonstrate the safety of this approach for suitable patients.
    Journal of the American College of Surgeons; 12/2014
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    ABSTRACT: Multivisceral resection is often required in the treatment of locally advanced rectal cancers. Such resections are relatively rare and oncologic outcomes, especially when sphincter preservation is performed, are not fully demonstrated. A retrospective review was conducted of patients who underwent multivisceral resection for locally advanced rectal cancer with and without sphincter preservation. Sixty-one patients underwent multivisceral resection for rectal cancer from 2005 to 2013 with a median follow-up of 27.8 months. Five-year overall and disease-free survival were 49.2% and 45.3%, respectively. Thirty-four patients (55.7%) had sphincter-sparing operations with primary coloanal anastomosis and temporary stoma. There was no significant difference in overall or disease-free survival, or recurrence with sphincter preservation compared with those with permanent stoma. Multivisceral resection for locally advanced rectal cancer has acceptable oncologic and clinical outcomes. Sphincter preservation and subsequent reestablishment of gastrointestinal continuity does not impact oncologic outcomes and should be considered in many patients. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Surgery 12/2014; 209(3). DOI:10.1016/j.amjsurg.2014.10.014 · 2.41 Impact Factor
  • Deborah S. Keller · Bridget O. Ermlich · Conor P. Delaney
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    ABSTRACT: Background Quality improvement in colorectal surgery (CRS) requires implementation of tools to improve patient and financial outcomes, and assessment of results. Our objective was to evaluate the durability of transversus abdominis plane (TAP) blocks and a standardized enhanced recovery protocol (ERP) on a large series of laparoscopic colorectal resections. Study Design 200 consecutive laparoscopic CRS patients received TAP blocks under laparoscopic guidance at the end of their operation. All were managed with a standardized ERP. Demographic, perioperative, and postoperative outcome variables were analyzed. The main outcome measures were length of stay (LOS), readmission, reoperation, morbidity, and mortality rates. Results Of 200 cases, 194 were elective and 6 emergent. The main diagnosis was colorectal cancer (45%). The mean age was 61.2 years, mean BMI was 29.2 kg/m2, and the majority (63%) were ASA class III. The main procedure performed was a segmental colectomy (64%). Mean operative time was 181 minutes. Nine cases (4.5%) were converted to open. The median LOS was 2 days (range, 1-8). 21% were discharged by postoperative day (POD) 1, 41% by POD2, and 77% by POD3. By POD7, 99% were discharged. 12% (n=24) had complications, and 6.5% (n=13) were readmitted. There were 3 unplanned reoperations and no mortalities. Comparing the first and second groups of 100 consecutive patients further tested the consistency of the TAP block benefit. With comparable demographics, there were no significant differences in readmission, complication, or reoperation rates over the entire series. Conclusions Adding TAP blocks to a ERP facilitated shorter LOS with low readmission and reoperation rates when compared to previously published series. The effect appears durable and consistent in a large case series. TAP blocks may be an efficient, cost-effective method for improving laparoscopic CRS results.
    Journal of the American College of Surgeons 12/2014; 219(6). DOI:10.1016/j.jamcollsurg.2014.08.011 · 4.45 Impact Factor
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    S E Araujo · B Crawshaw · C R Mendes · C P Delaney
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    ABSTRACT: Achieving a clear distal or circumferential resection margins with laparoscopic total mesorectal excision (TME) may be laborious, especially in obese males and when operating on advanced distal rectal tumors with a poor response to neoadjuvant treatment. Transanal (TaTME) is a new natural orifice translumenal endoscopic surgery modality in which the rectum is mobilized transanally using endoscopic techniques with or without laparoscopic assistance. We conducted a comprehensive systematic review of publications on this new technique in PubMed and Embase databases from January, 2008, to July, 2014. Experimental and clinical studies written in English were included. Experimental research with TaTME was done on pigs with and without survival models and on human cadavers. In these studies, laparoscopic or transgastric assistance was frequently used resulting in an easier upper rectal dissection and in a longer rectal specimen. To date, 150 patients in 16 clinical studies have undergone TaTME. In all but 15 cases, transabdominal assistance was used. A rigid transanal endoscopic operations/transanal endoscopic microsurgery (TEO/TEM) platform was used in 37 patients. Rectal adenocarcinoma was the indication in all except for nine cases of benign diseases. Operative times ranged from 90 to 460 min. TME quality was deemed intact, satisfactory, or complete. Involvement in circumferential resection margins was detected in 16 (11.8 %) patients. The mean lymph node harvest was equal or greater than 12 in all studies. Regarding morbidity, pneumoretroperitoneum, damage to the urethra, and air embolism were reported intraoperatively. Mean hospital stay varied from 4 to 14 days. Postoperative complications occurred in 34 (22.7 %) patients. TaTME with TEM is feasible in selected cases. Oncologic safety parameters seem to be adequate although the evidence relies on small retrospective series conducted by highly trained surgeons. Further studies are expected.
    Techniques in Coloproctology 11/2014; 19(2). DOI:10.1007/s10151-014-1233-x · 1.34 Impact Factor
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    ABSTRACT: Superior early pain control has been suggested with transversus abdominis plane blocks, but evidence-based recommendations for transversus abdominis plane blocks and their effects on patient outcomes are lacking.
    Diseases of the Colon & Rectum 11/2014; 57(11):1290-1297. DOI:10.1097/DCR.0000000000000211 · 3.20 Impact Factor
  • American College of Surgeons 2014, San Francisco; 10/2014
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    ABSTRACT: Background Factors influencing recurrence of ileocecal Crohn’s disease (CD) after surgical resection may differ between adolescents and adults. Methods Crohn’s disease patients who underwent ileocecectomy were retrospectively divided into pediatric onset (age at diagnosis ≤16, n=34) and adult onset (>16, n=108) patients to evaluate differences in risks of endoscopic and clinical recurrence. Results In 142 patients, rates of any recurrence, endoscopic and clinical recurrence at 5 years were 78%, 88% and 65%, respectively. Risks of recurrence were similar between groups. Younger patients were more likely to be on immunologics preoperatively and more likely to be started on immunoprophylaxis postoperatively. Immediate postoperative prophylaxis was predictive of delayed clinical recurrence only in the older group. Conclusion Despite increased preoperative and postoperative immunoprophylaxis in younger patients, recurrence rates of CD after ileocecectomy do not differ between these groups. Immediate postoperative prophylaxis was predictive of delayed clinical recurrence only in patients with adult onset CD..
    The American Journal of Surgery 10/2014; 208(4). DOI:10.1016/j.amjsurg.2014.06.008 · 2.41 Impact Factor
  • Deborah S. Keller · Brian Swendseid · Sadaf Khan · Conor P. Delaney
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    ABSTRACT: Background Our objective was to evaluate ileostomy reversal patients managed with a standardized Enhanced Recovery Pathway to identify factors associated with readmissions. Methods Prospective review database identified ileostomy reversal patients. Variables for the index admission and readmission were evaluated. Results 332 patients were analyzed. The primary diagnosis was colorectal cancer (57.6%). 13% were discharged by postoperative day (POD) 1, 47% by POD2, and 65% by POD3. The complication rate was 16.8%. The main complication was ileus/small bowel obstruction (n=27). 30-day readmission rate was 12.4% (n=41); small bowel obstruction (n=27) was the most frequent readmission diagnosis. The median readmission POD was 7. Only 1 patient had a follow-up visit prior to readmission. The median readmission length of stay was 4 days. Conclusions Most ileostomy reversals readmissions occur before the first follow-up and stem from preventable causes. An Enhanced Recovery Pathway modification may improve outcomes and utilization in this group. Classifications Ileostomy, Enhanced Recovery Pathways, Patient Outcomes, Readmission Rates, Colorectal Surgery
    The American Journal of Surgery 10/2014; 208(4). DOI:10.1016/j.amjsurg.2014.05.003 · 2.41 Impact Factor
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    ABSTRACT: Objective: To establish a structured international expert consensus on a detailed technical description of the laparoscopic total mesorectal excision (TME). Background: Laparoscopic TME is a common surgical approach for the treatment of rectal cancer, but there is little agreement on technical details and standards. Methods: Sixty leading surgical experts from 5 different world regions with a median overall experience of 250 laparoscopic TME participated in this study. Four stages of mixed quantitative and qualitative consensus-finding methods were applied. (1) Semistructured expert interviews were independently analyzed by 2 assessors. (2) Consensus on the interview data was reached using reiterating questionnaires (Delphi method). (3) This was further refined in an interactive workshop. (4) Based on this meeting, a comprehensive text was drafted and final approval was sought by all experts. Findings: Three theme categories were identified in 9 detailed interviews (anatomical landmarks, description of tissue retraction, and operating strategies). Following 2 rounds of a 54-item questionnaire, 29 items achieved very high agreement (A* >=90%), 14 with good agreement (>=80%), 13 with moderate agreement (>=50%), and 18 with little or no agreement (<50%). In the workshop, areas of agreement were consolidated and conclusions were sought for those with less agreement. The final document was approved after 2 further rounds of surveys by all respondents. Conclusions: This detailed and agreed technical description of laparoscopic TME may have implications on training, assessment, quality control, and future research.
    Annals of Surgery 07/2014; 261(4). DOI:10.1097/SLA.0000000000000823 · 8.33 Impact Factor
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    ABSTRACT: Surgical Telementoring using a tablet - bridges two continents In January 2014, Dr. Conor Delaney and Dr. Knut Magne Augestad at University Hospitals Case Medical Center assisted Dr. Rolv-Ole Lindsetmo at University Hospital North Norway, 6500 miles apart, in the first transatlantic telementored surgical sessions ever performed using a tablet PC. Two patients with colorectal cancer were operated on in Norway, and during the surgeries the US based team assisted in identifying key anatomical locations and surgical planes for dissection. “Telementoring on tablet PCs is a fascinating and innovative solution,” says Professor Conor Delaney, Chief of the Department of Colorectal Surgery, University Hospitals Case Medical Center in Cleveland. “The fact that we were able to perform transatlantic telestration (drawings over a live videostream) enhanced the mentors teaching capabilities and made it so much easier to reach a common agreement on the key surgical anatomical locations. The mobility of the technology is also of key importance, as mentors can connect to any Wi-fi or fast HSPA (High speed packet access) 3G-cellphone network, or the new or the new LTE (4G) mobile network. In a busy hospital workday, this is a huge advantage,” says Dr. Delaney. In Norway, Dr. Lindsetmo, chief at the Department of Gastrointestinal Surgery, University Hospital North Norway, is in charge of a hospital telementoring network. “At present we aim to connect several local hospitals to a University Hospital. This will contribute to build surgeon-networks that have the potential of helping surgeons out of difficult situations in the operating theatre.
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    ABSTRACT: Most patients treated with curative intent for colorectal cancer (CRC) are included in a follow-up program involving periodic evaluations. The survival benefits of a follow-up program are well delineated, and previous meta-analyses have suggested an overall survival improvement of 5%-10% by intensive follow-up. However, in a recent randomized trial, there was no survival benefit when a minimal vs an intensive follow-up program was compared. Less is known about the potential side effects of follow-up. Well-known side effects of preventive programs are those of somatic complications caused by testing, negative psychological consequences of follow-up itself, and the downstream impact of false positive or false negative tests. Accordingly, the potential survival benefits of CRC follow-up must be weighed against these potential negatives. The present review compares the benefits and side effects of CRC follow-up, and we propose future areas for research.
    05/2014; 6(5):104-111. DOI:10.4251/wjgo.v6.i5.104
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    ABSTRACT: There is an increasing trend to use laparoscopy for rectal cancer surgery. Although laparoscopic and open rectal resections appear oncologically equivalent, there is little information on the cost of different surgical approaches. With the current health care crisis and the importance of optimizing health care resources and patient outcomes, the cost of care is an important factor. The aim of this study was to evaluate the cost-effectiveness of laparoscopy in rectal cancer. This was a case-matched study. This study was conducted at a tertiary referral center. Patients undergoing elective rectal cancer resection between 2007 and 2012 were selected. A review of a prospective database for elective laparoscopic rectal cancer resections was performed. Laparoscopic cases were matched to open cases based on age, BMI, operative procedure, and diagnostic-related group. The primary outcomes measured were the cost of care, hospital length of stay, discharge disposition, readmission, postoperative complications, and mortality rates. Two hundred fifty-four matched cases were included in the analysis: 125 laparoscopic (49%) and 129 open (51%). The cTNM stage (p = 0.39), tumor distance from the anal verge (p = 0.07), and rate of neoadjuvant therapy received between the laparoscopic and open groups were similar (p = 0.12). Operating time (p< 0.01) and cost per operating room minute (p = 0.04) were significantly higher in the open group. The groups were oncologically equivalent, based on circumferential resection margin (p = 0.15). The laparoscopic group had a significantly shorter length of stay (p < 0.01) and lower total hospital cost (p < 0.01). Postoperative complications, 30-day readmission, reoperation, and mortality rates were similar. However, significantly more patients undergoing open resection required intensive care unit care (p = 0.03), skilled nursing (p = 0.03), or home care services (p < 0.01) at discharge. This investigation was conducted at a single institution and it is a retrospective study with potential bias. Laparoscopy is cost-effective for rectal cancer surgery, improving both health care expenditures and patient outcomes. For selected patients, laparoscopic rectal cancer resection can reduce length of stay, operating time, and resource utilization.
    Diseases of the Colon & Rectum 05/2014; 57(5):564-9. DOI:10.1097/DCR.0b013e3182a73244 · 3.20 Impact Factor
  • Annals of surgery 03/2014; 261(5). DOI:10.1097/SLA.0000000000000679 · 7.19 Impact Factor
  • Liane S Feldman · Conor P Delaney
    Surgical Endoscopy 03/2014; 28(5). DOI:10.1007/s00464-013-3415-4 · 3.31 Impact Factor

Publication Stats

7k Citations
1,027.48 Total Impact Points

Institutions

  • 2007–2014
    • Case Western Reserve University School of Medicine
      • Department of Surgery
      Cleveland, Ohio, United States
    • Medical University of Ohio at Toledo
      • Department of Surgery
      Toledo, Ohio, United States
    • Cornell University
      • Department of Surgery
      Итак, New York, United States
  • 2006–2014
    • Case Western Reserve University
      • Division of Colorectal Surgery
      Cleveland, Ohio, United States
  • 2006–2011
    • Cleveland State University
      Cleveland, Ohio, United States
  • 2005–2007
    • Cleveland Clinic
      • Department of Cancer Biology
      Cleveland, Ohio, United States