Vol.:(0123456789) 1 3 Updates in Surgery https://doi.org/10.1007/s13304-020-00879-3 ORIGINAL ARTICLE A comparative cost analysis of transanal and laparoscopic total mesorectal excision for rectal cancer Francesca Di Candido 1  · Michele Carvello 1  · Deborah S. Keller 2  · Elena Vanni 3,4  · Annalisa Maroli 1  · Isacco Montroni 5  · Roel Hompes 6  · Matteo Sacchi 1  · Marco Montorsi 7  · Antonino Spinelli 1,4 Received: 25 June 2020 / Accepted: 30 August 2020 © Italian Society of Surgery (SIC) 2020 Abstract Despite proven clinical benefts in the short term, technical difculties limit utilization of laparoscopy in rectal cancer surgery (RCS). Transanal Total Mesorectal Excision (taTME) overcomes many technical limitations of laparoscopic RCS. However, the costs of this procedure have not been addressed yet. Our goal was to perform a comparative cost analysis of taTME and laparoscopic TME (lapTME). Consecutive patients undergoing curative TME between 1 February 2014 and 31 October 2018 were selected from a prospectively maintained database and stratifed, according to the type of procedure, into taTME and lapTME groups. Patient demographics, tumour characteristics, operative parameters, and short-term outcomes were analyzed. The main outcome measure was intraoperative costs of the two procedures. Secondary outcomes were short- term outcome and the utilization of hospital resources to manage the postoperative course. Hundred and ffty-two patients with rectal cancer (66 lapTME, 86 taTME) were included in the study. Surgical supplies required for taTME procedure exceeded the cost of lapTME of 754,54 €. The duration of surgery was not signifcantly diferent between the two approaches (266 ± 92.85 vs 271 ± 83.63, p = 0.50). Short-term outcomes were comparable including postoperative complication rate (17 vs 20%, p = 0.68), reintervention rate, and length of stay. There was no diference in hospital resources utilization to manage postoperative course including blood test, diagnostics, consultations, and medications. TaTME has higher intraoperative costs in terms of supplies with respect to lapTME. Short-term outcomes and hospital resources to manage postoperative course are comparable. Keywords Rectal cancer · Total mesorectal excision (TME) · Laparoscopic total mesorectal excision (lapTME) · Transanal total mesorectal excision (taTME) · Cost analysis · Francesca Di Candido and Michele Carvello share co-frst authorship. Introduction The introduction of laparoscopy has revolutionized colorec- tal surgery (CRS) providing several benefts such as faster recovery, lower complication and readmission rate [1–4]. With continuous experience and evidence of improved outcomes, laparoscopy has become more cost-effective than open CRS [5, 6]. Similarly, laparoscopy has been spe- cifcally and progressively applied in rectal cancer surgery (RCS) with increased evidence on comparable costs and out- comes with respect to open approach [7–9]. However, tech- nical difculties related to the laparoscopic approach to the pelvis limit the ability to perform an ideal total mesorectal excision (TME) for the best recurrence and survival out- comes in RCS [10–13]. New approaches to accomplish TME have been proposed to overcome the technical limitations of laparoscopic RCS. Indeed, transanal TME (taTME) provides the benefts of MIS along with better visualization of the lower third of the mesorectum during dissection and precise rectal transection by mastering the distal tumor margin [14–16]. Furthermore, the possibility to perform a double purse-string single-sta- pled anastomosis has the potential to reduce postoperative leak rate [17]. Since the introduction of taTME, multiple studies have described potential advantages, safety, feasibil- ity, short-term outcomes for RCS [15, 18, 19]. Recently, the oncological safety of taTME has been called into question. In fact, the Norwegian report by Larsen et al. showing a higher local recurrence rates with an unexpected multifocal pathway has prompted a nationwide cessation of * Antonino Spinelli antonino.spinelli@hunimed.eu Extended author information available on the last page of the article