Cost analysis of a watch-and-wait approach in patients with a complete clinical response to chemoradiotherapy for rectal cancer

Comparing outcomes and cost in surgery versus watch & wait surveillance of patients with rectal cancer post neoadjuvant long course chemoradiotherapy

BACKGROUND

Watch and wait (W&W) in complete clinical responders after neoadjuvant chemoradiotherapy has increasingly robust data supporting its oncological safety. Recently, studies have assessed the real-world costs of this strategy compared to surgical resection. Our aim was to compare our oncological safety and costs associated with operative and surveillance strategies to international literature.

METHODS

Data were retrospectively collected and analysed via electronic health records from March 2014 to March 2021 in Christchurch, New Zealand. Two cohorts were created based on intention to treat. All hospital events were recorded and costed, as well as oncologic outcomes. Our primary endpoints were the cumulative cost of both strategies, 3-year survival rate, and disease-free survival.

RESULTS

Forty-eight patients were identified who had rectal cancers resected (OT) with a yPT0N0 pathology, and 42 who were on the wait-and-watch (W&W) audit after having a clinical complete response. After exclusions, we identified 38 OT and 23 W&W patients; the W&W group were more co-morbid (P = 0.05), had worse functional status (P = 0.008), higher BMI (P = 0.34) and more favourable clinical tumour staging (P = 0.01). The operative treatment (OT) group (n = 38) had more acute admissions (34% versus 13% in W&W, P = 0.08, OR 0.29). There was a 35.7% (n = 8 of 23) local recurrence in W&W and none in the OT group (P ≤ 0.001), with successful salvage in the W&W with local recurrence in 71.5% (n = 5 of 7). Three-year distant metastasis-free rate was 97.3% in the OT group and 90.9% in W&W (p = 0.05). Overall survival was 100% (W&W) and 94.7% (OT); (P = 0.019). Care in the OT group cost more than W&W, accounting for local regrowth management; $NZ70,759.56 versus $NZ47,905.52 (P = 0.014).

CONCLUSION

This study found better oncological outcomes in the OT group, whilst the W&W group had reduced morbidity and acute bed days. The cost of wait and watch was approximately two-thirds that of operative treatment, even accounting for salvage procedures for local regrowth.

Application of multimodal identification technology in the innovative management operation department

Background

The optimization of surgical procedures and the management of surgical quality and safety have become the focus of attention of hospital managers. The application of multimodal identification technology in the innovative management mode of hospital operating department has made remarkable progress.

Methods

To investigate the effect of the upgraded multimodal identification technology on the innovative management of the operating department, 2,280 cases of laparoscopic surgery using traditional surgical management procedures from January to December 2019 before the management upgrade were set as the control group, and 2,350 laparoscopic surgeries with the upgraded multimodal identification management process from January to December 2020 were selected as the experimental group. The operating efficiency, material management efficiency, and patient experience and satisfaction of the two groups were investigated and compared.

Results

Compared with traditional procedures, the upgraded multimodal surgical management system significantly improves the efficiency of laparoscopic surgery and reduces surgical consumption and costs. In addition, the multimodal surgical information identification system significantly improves the surgical experience for patients undergoing laparoscopic surgery.

Conclusion

Application of multimodal identification technology improves the innovative management of operation department compared with traditional surgery management procedure.