Objective. The purpose of this study was to determine whether the cost asso
ciated with treatment of early stage endometrial cancer differs on the basi
s of the surgical approach.
Methods. A retrospective analysis was performed on a series of women with p
resumed early stage endometrial cancer treated between 5/96 and 1/99 at a s
ingle institution. The patients were grouped according to the surgical appr
oach utilized. The first group consisted of 19 patients who underwent lapar
oscopic assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and
laparoscopic pelvic and paraaortic lymph node dissection. The second group
consisted of 17 patients who underwent a total abdominal hysterectomy, bil
ateral salpingo-oophorectomy, and pelvic and paraaortic lymph node disectio
n. The two groups were compared with a two-tailed Student t test. Variables
analyzed included age, Quetelet index (QI), surgical stage, number of lymp
h nodes, surgical time, estimated blood loss, postoperative complications,
number of days in the hospital, and costs. The cost analysis was divided in
to room and board, pharmacy, ancillary services, operating room equipment,
operating room services, and anesthesia.
Results. Both groups were similar in age, QI, and distribution of stage. Th
e laparoscopic group required more OR time (237 vs 157 min, P < 0.001); how
ever, the number of lymph nodes, estimated blood loss, and postoperative co
mplications were not significantly different between the groups. The laparo
scopic group required significantly shorter hospitilization than the laparo
tomy group (3.7 vs 5.2 days, P < 0.001) resulting in less room and board ($
299 vs $454, P < 0.001) as well as pharmacy costs ($443 vs $625, P < 0.02).
The cost of anesthesia was higher in the laparoscopic group ($696 vs $444,
P < 0.001) but the costs of OR equipment, OR services, and total costs wer
e not statistically different between the groups.
Conclusion. Laparoscopic surgical management of early stage endometrial can
cer is feasible with minimal morbidity. The cost savings of early hospital
discharge is offset by longer surgical time and higher anesthetic costs. Th
e total costs for each surgical approach are not statistically different. T
he presumed advantages of less pain, early resumption of normal activities,
and overall improvement of quality of life await further investigation. (C
) 1999 Academic Press.