A STUDY AND EVALUATION OF MAKEOWN'S ESOPHAGECTOMY OUTCOMES WITH COST AND BENEFIT ANALYSIS: A SINGLE INSTITUTIONAL REVIEW

Abstract

Background: A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of outcomes including the costs and benefits of Hybrid and open esophagectomy approaches for esophageal cancer surgery.

Methods: The data of 15 consecutive patients who underwent a McKeown's esophagectomy at Sri Aurobindo Institute of Medical Science and Post Graduate Institute (SAIMS and PGI), Indore between November 2017 and October 2019 were analysed. Open esophagectomy was performed in 10 patients, and hybrid esophagectomy in 05. There were no differences in patient characteristics among the 2 groups. Hybrid esophagectomy via a thoracoscopic-laparotomy approach and open esophagectomy by a thoracotomy-laparotomy approach.

Results: Hybrid esophagectomy required a longer operative time than open esophagectomy (p value 0.02), but these patients reported less postoperative pain (p value 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 2 groups. Hybrid esophagectomy incurred higher operative and surgical material cost and inpatient care and total hospital costs than open esophagectomy (p value 0.01).

Conclusion: Hybrid esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain.