S Baffert1, S Alran2, V Fourchotte3, M A Traore4, C Simondi5, P Mathevet6, C Loustalot7, C Binelli8, I Jaffre9, E Barranger10, P F Dupre11, G Ferron12, G Houvenaeghel13, J Leveque14, P Descamps15, G Body16, D Raudrant17, J M Classe18. 1. Department of Health Technology Assessment, Health Economic Unit, Fondation A de Rothschild, Paris, France. Electronic address: sbaffert@fo-rothschild.fr. 2. Surgical Department, Institut Curie, Paris, France. Electronic address: severine.alran@curie.fr. 3. Surgical Department, Institut Curie, Paris, France. Electronic address: virginie.fourchotte@curie.fr. 4. Department of Health Technology Assessment, Health Economic Unit, Fondation A de Rothschild, Paris, France. Electronic address: marie-angele.traore@curie.fr. 5. Clinical Research Department, Trial Management Unit, Institut Curie, Paris, France. Electronic address: cecile.simondi@curie.fr. 6. Surgical Department, CHU Lyon, France. Electronic address: Patrice.Mathevet@chuv.ch. 7. Surgical Department, Centre GF Leclerc, Dijon, France. Electronic address: cloustalot@cgfl.fr. 8. Surgical Department, Clinique mutualiste Jules Verne, Nantes, France. Electronic address: christophe.binelli@mla.fr. 9. Surgical Department, Institut de Cancerologie de l'Ouest, Center Gauducheau, Nantes, France. Electronic address: isabelle.jaffre@ico.unicancer.fr. 10. Surgical Department, Hôpital Lariboisière, AP-HP, Paris, France. Electronic address: Emmanuel.BARRANGER@nice.unicancer.fr. 11. Surgical Department, CHU Brest, Brest, France. Electronic address: pierre-francois.dupre@chu-brest.fr. 12. Surgical Department, Institut Claudius Regaud, Toulouse, France. Electronic address: ferron.gwenael@claudiusregaud.fr. 13. Surgical Department, Institut Paoli Calmettes, Marseille, France. Electronic address: houvenag@ipc.unicancer.fr. 14. Surgical Department, CHU Rennes Sud, Rennes, France. Electronic address: jean.leveque@chu-rennes.fr. 15. Surgical Department, CHU, Angers, France. Electronic address: phdescamps@chu-angers.fr. 16. Surgical Department, CHU, Tours, France. Electronic address: body@med.univ-tours.fr. 17. Surgical Department, CHU Lyon Sud, Lyon, France. Electronic address: daniel.raudrant@chu-lyon.fr. 18. Surgical Department, Institut de Cancerologie de l'Ouest, Center Gauducheau, Nantes, France. Electronic address: jean-marc.classe@ico.unicancer.fr.
Abstract
OBJECTIVE: Laparoscopy allows hysterectomies after chemoradiation to be performed without opening the abdominal wall. We measured the costs and quality of life for locally advanced cervical cancer patients operated on via laparoscopy compared to laparotomy. STUDY DESIGN: We conducted an observational prospective multicenter study on locally advanced cervical cancer patients undergoing an extrafascial hysterectomy after concurrent chemoradiotherapy (CRT). We assessed the costs from the medical visit before surgery up to the first month after surgery from the providers' perspective and measured the quality of life using the EORTC QLQ-C30 and QLQ-CX24 up to six months. RESULTS: Sixty two patients (39 laparoscopy and 23 laparotomy) from December 2008 to November 2011 were included. There was no difference in operative time, or intraoperative and post-operative complication rates between the two groups. Intraoperative transfusion and abdominal drain were significantly lower in the laparoscopy group (respectively, p = 0.04 and p < 0.01), as well as the duration of hospital stay (7.3 d vs. 5.7 d, p < 0.001). All patients who underwent laparoscopic hysterectomy were discharged to home, whereas 4 laparotomy patients used convalescence homes (p = 0.01). Mean costs at one month were €10,991 for laparotomy and €11,267 for laparoscopy (p = 0.76). Sexual activity is better for the laparoscopy group at six months (p = 0.01). CONCLUSION: Laparoscopy for an extrafascial hysterectomy after CRT in locally advanced cervical cancer patients brought better quality of life with similar costs compared to laparotomy, and should therefore be the first choice for surgeons.
OBJECTIVE: Laparoscopy allows hysterectomies after chemoradiation to be performed without opening the abdominal wall. We measured the costs and quality of life for locally advanced cervical cancerpatients operated on via laparoscopy compared to laparotomy. STUDY DESIGN: We conducted an observational prospective multicenter study on locally advanced cervical cancerpatients undergoing an extrafascial hysterectomy after concurrent chemoradiotherapy (CRT). We assessed the costs from the medical visit before surgery up to the first month after surgery from the providers' perspective and measured the quality of life using the EORTC QLQ-C30 and QLQ-CX24 up to six months. RESULTS: Sixty two patients (39 laparoscopy and 23 laparotomy) from December 2008 to November 2011 were included. There was no difference in operative time, or intraoperative and post-operative complication rates between the two groups. Intraoperative transfusion and abdominal drain were significantly lower in the laparoscopy group (respectively, p = 0.04 and p < 0.01), as well as the duration of hospital stay (7.3 d vs. 5.7 d, p < 0.001). All patients who underwent laparoscopic hysterectomy were discharged to home, whereas 4 laparotomy patients used convalescence homes (p = 0.01). Mean costs at one month were €10,991 for laparotomy and €11,267 for laparoscopy (p = 0.76). Sexual activity is better for the laparoscopy group at six months (p = 0.01). CONCLUSION: Laparoscopy for an extrafascial hysterectomy after CRT in locally advanced cervical cancerpatients brought better quality of life with similar costs compared to laparotomy, and should therefore be the first choice for surgeons.