Abstract
Background
Laparoscopic distal pancreatectomy (LDP) is being increasingly performed with some concerns regarding the cost of the minimally invasive approach. The purpose of this study was to assess the cost-effectiveness of LDP versus open distal pancreatectomy (ODP).
Methods
A retrospective clinical and cost-comparison analysis was performed for patients who underwent LDP vs. OPD between 2005 and 2011. Data considered for the comparison analysis were: operative costs (surgical procedure, operative time, blood transfusions), postoperative costs (laboratory testing, hospital stay, complication management, readmissions), and overall costs.
Results
Fifty-one distal pancreatectomies (laparoscopic = 35, open = 16) were performed during the study period. The median operative time was 200 (range, 120–420) min for LDP vs. 225 (range, 120–460) min for ODP (p = 0.93). Median blood loss was 200 (range, 50–900) mL for LDP vs. 394 (range, 75–2000) mL for ODP (p = 0.038). Median hospital stay was 7 (range, 3–25) days in the laparoscopic group vs. 11 (range, 5–46) days in the open group (p = 0.007). Complication rate was 40% for LDP vs. 69% in ODP (p = 0.075). Postoperative intervention was required in 11% of patients after LDP vs. 31% after ODP (p = 0.12). The average operative, postoperative, and overall cost was £6039 (range, £4276–£9500), £4547 (range, £1299–£13937), £10587 (range, £6508–£20303) vs. £5231 (range, £3409–£9330), £10094 (range, £2665–£39291), £15324 (range, £7209–£47484) for the LDP and ODP groups, respectively (p = 0.033; p = 0.006; p = 0.197).
Conclusions
We showed that LDP is feasible and safe without having a negative impact on cost. Extensive experience in pancreatic and laparoscopic surgery is required to optimize surgical outcomes.
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References
Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin RC 2nd, Scoggins CR, Ahmad S, Kim HJ, Park J, Johnston F, Strouch MJ, Menze A, Rymer J, McClaine R, Strasberg SM, Talamonti MS, Staley CA, McMasters KM, Lowy AM, Byrd-Sellers J, Wood WC, Hawkins WG (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248:438–446
Kang CM, Kim DH, Lee WJ (2010) Ten years of experience with resection of left-sided pancreatic ductal adenocarcinoma: evolution and initial experience to a laparoscopic approach. Surg Endosc 24:1533–1541
Ammori BJ, Ayiomamitis GD (2011) Laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a UK experience and a systematic review of the literature. Surg Endosc. doi:10.1007/s00464-010-1538-4, 7 Feb 2011
Jayaraman S, Gonen M, Brennan MF, D’Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR, Allen PJ (2010) Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. J Am Coll Surg 211:503–509
Finan KR, Cannon EE, Kim EJ, Wesley MM, Arnoletti PJ, Heslin MJ, Christein JD (2009) Laparoscopic and open distal pancreatectomy: a comparison of outcomes. Am Surg 75:671–679
Tiwari MM, Reynoso JF, High R, Tsang AW, Oleynikov D (2011) Safety, efficacy, and cost-effectiveness of common laparoscopic procedures. Surg Endosc 25:1127–1135
Abu Hilal M, Jain G, Kasasbeh F, Zuccaro M, Elberm H (2009) Laparoscopic distal pancreatectomy: critical analysis of preliminary experience from a tertiary referral centre. Surg Endosc 23:2743–2747
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13
Waters JA, Canal DF, Wiebke EA, Dumas RP, Beane JD, Aguilar-Saavedra JR, Ball CG, House MG, Zyromski NJ, Nakeeb A, Pitt HA, Lillemoe KD, Schmidt CM (2010) Robotic distal pancreatectomy: cost effective? Surgery 148:814–823
Vijan SS, Ahmed KA, Harmsen WS, Que FG, Reid-Lombardo KM, Nagorney DM, Donohue JH, Farnell MB, Kendrick ML (2010) Laparoscopic vs open distal pancreatectomy: a single-institution comparative study. Arch Surg 145:616–621
Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC 3rd, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 210:779–785, 786–787.
Disclosures
Mr. Mohammad Abu Hilal, Mr. Mohammed Hamdan, Mr. Francesco Di Fabio, Mr. Neil W. Pearce, and Mr. Colin D. Johnson have no conflicts of interest or financial ties to disclose.
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Abu Hilal, M., Hamdan, M., Di Fabio, F. et al. Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study. Surg Endosc 26, 1670–1674 (2012). https://doi.org/10.1007/s00464-011-2090-6
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DOI: https://doi.org/10.1007/s00464-011-2090-6