Surgical Endoscopy

, Volume 26, Issue 7, pp 1830–1836 | Cite as

Laparoscopic and open surgical treatment of left-sided pancreatic lesions: clinical outcomes and cost-effectiveness analysis

  • Paolo Limongelli
  • Andrea Belli
  • Gianluca Russo
  • Luigi Cioffi
  • Alberto D’Agostino
  • Corrado Fantini
  • Giulio Belli



Previous studies comparing open distal pancreatectomy (ODP) and laparoscopic distal pancreatectomy (LDP) have found advantages related to minimal-access surgery. Few studies have compared direct and associated costs after LDP versus ODP. The purpose of the current study was to compare perioperative outcomes of patients undergoing LDP and ODP and to assess whether LDP was a cost-effective procedure compared with the traditional ODP.


A retrospective analysis of a prospectively maintained database of 52 distal pancreatic resections that were performed during a 10-year period was performed.


Patients included in the analysis were 16 in the LDP group and 29 in the ODP. Tumors operated laparoscopically were smaller than those removed at open operation, but the length of pancreatic resection was similar. The mean operating time for LDP was longer than ODP (204 ± 31 vs. 160 ± 35; P < 0.0001), whereas blood loss was higher in the open group (365 ± 215 vs. 160 ± 185, P < 0.0001). Morbidity (25 vs. 41; P = 0.373) and pancreatic fistula (18 vs. 20%; P = 0.6) rates were similar after LDP and ODP, as was 30-day mortality (0 vs. 2%; P = 0.565). LDP had a shorter mean length of hospital stay than ODP (6.4 (2.3) vs. 8.8 (1.7) days; P < 0.0001). Operative cost for LDP was higher than ODP (€2889 vs. €1989; P < 0.0001). The entire cost of the associated hospital stay was higher in the ODP group (€8955 vs. €6714; P < 0.043). The total cost was comparable in LDP and ODP groups (€9603 vs. €10944; P = 0.204).


Laparoscopic distal pancreatectomy for left-sided lesions can be performed safely and effectively in selected patients, with reduced hospital stay and operative blood loss. Major complications, including pancreatic leak, were not reduced, whereas total cost was comparable between LDP and ODP. A selective use of LDP seems to be an effective and cost-efficient alternative to ODP.


Distal pancreatectomy Laparoscopy Laparoscopic pancreatic resection Open distal pancreatectomy 



Drs. Paolo Limongelli, Andrea Belli, Gianluca Russo, Luigi Cioffi, Alberto D’Agostino, Corrado Fantini, and Giulio Belli have no conflicts of interest or financial ties to disclose.


  1. 1.
    John TG, Greig JD, Carter DC, Garden OJ (1995) Carcinoma of the pancreatic head and periampullary region: tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg 221:156–164PubMedCrossRefGoogle Scholar
  2. 2.
    Takaori K, Tanigawa N (2007) Laparoscopic pancreatic resection: the past, present, and future. Surg Today 37:535–545PubMedCrossRefGoogle Scholar
  3. 3.
    Sa Cunha A, Rault A, Beau C, Laurent C, Collet D, Masson B (2008) A single-institution prospective study of laparoscopic pancreatic resection. Arch Surg 143:289–295PubMedCrossRefGoogle Scholar
  4. 4.
    Briggs CD, Mann CD, Irving GR, Neal CP, Peterson M, Cameron IC, Berry DP (2009) Systematic review of minimally invasive pancreatic resection. J Gastrointest Surg 13:1129–1137PubMedCrossRefGoogle Scholar
  5. 5.
    Baker MS, Bentrem DJ, Ujiki MB, Stocker S, Talamonti MS (2009) A prospective single-institution comparison of perioperative outcomes for laparoscopic and open distal pancreatectomy. Surgery 146:635–643PubMedCrossRefGoogle Scholar
  6. 6.
    Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin RC II, 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 248:438–446PubMedGoogle Scholar
  7. 7.
    DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244:931–937 discussion 937–939PubMedCrossRefGoogle Scholar
  8. 8.
    Bassi C, Dervenis MK, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRefGoogle Scholar
  9. 9.
    Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120:1051–1054PubMedCrossRefGoogle Scholar
  10. 10.
    Mabrut J-Y, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF; Hepatobiliary and Pancreatic Section (HBPS) of the Royal Belgian Society of Surgery; Belgian Group for Endoscopic Surgery (BGES); Club Coelio (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137:597–605Google Scholar
  11. 11.
    Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 246:77–82PubMedCrossRefGoogle Scholar
  12. 12.
    Belli G, Limongelli P, Fantini C, D’Agostino A, Cioffi L, Belli A, Russo G (2009) Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 96:1041–1048PubMedCrossRefGoogle Scholar
  13. 13.
    Knaebel HP, Diener MK, Wente MN, Büchler MW, Seiler CM (2005) Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 92:539–546PubMedCrossRefGoogle Scholar
  14. 14.
    Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch OR, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Büchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377(9776):1514–1522PubMedCrossRefGoogle Scholar
  15. 15.
    Weber SM, Cho CS, Merchant N, Pinchot S, Rettammel R, Nakeeb A, Bentrem D, Parikh A, Mazo AE, Martin RC III, Scoggins CR, Ahmad SA, Kim HJ, Hamilton N, Hawkins W, Max Schmidt C, Kooby DA (2009) Laparoscopic left pancreatectomy: complication risk score correlates with morbidity and risk for pancreatic fistula. Ann Surg Oncol 16(10):2825–2833PubMedCrossRefGoogle Scholar
  16. 16.
    Cho CS, Kooby DA, Schmidt CM, Nakeeb A, Bentrem DJ, Merchant NB, Parikh AA, Martin RC II, Scoggins CR, Ahmad SA, Kim HJ, Hamilton N, Hawkins WG, Weber SM (2011) Laparoscopic versus open left pancreatectomy: can preoperative factors indicate the safer technique? Ann Surg 253(5):975–980PubMedCrossRefGoogle Scholar
  17. 17.
    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(4):503–509PubMedCrossRefGoogle Scholar
  18. 18.
    Matsumoto T, Shibata K, Ohta M, Iwaki K, Uchida H, Yada K, Mori M, Kitano S (2008) Laparoscopic distal pancreatectomy and open distal pancreatectomy: a nonrandomized comparative study. Surg Laparosc Endosc Percutan Tech 18:340–343PubMedCrossRefGoogle Scholar
  19. 19.
    Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW, Lee SK, Kim MH, Han DJ (2008) Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 22:2261–2268PubMedCrossRefGoogle Scholar
  20. 20.
    Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW (2008) Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc 2:1334–1338CrossRefGoogle Scholar
  21. 21.
    Nigri GR, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, Ramacciato G, Melis M (2011) Meta-analysis of trials comparing minimally invasive and open distal pancreatectomies. Surg Endosc 25(5):1642–1651 Epub 2010 Dec 24PubMedCrossRefGoogle Scholar
  22. 22.
    Baker MS, Bentrem DJ, Ujiki MB, Stocker S, Talamonti MS (2011) Adding days spent in readmission to the initial postoperative length of stay limits the perceived benefit of laparoscopic distal pancreatectomy when compared with open distal pancreatectomy. Am J Surg 201(3):295–299 discussion 299-300PubMedCrossRefGoogle Scholar
  23. 23.
    Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192PubMedCrossRefGoogle Scholar
  24. 24.
    Liang JT, Huang KC, Lai HS, Lee PH, Jeng YM (2007) Oncologic results of laparoscopic versus conventional open surgery for stage II and III left-sided colon cancers: a randomized controlled trial. Ann Surg Oncol 14:109–117PubMedCrossRefGoogle Scholar
  25. 25.
    Belli G, Fantini C, Ciciliano F, D’Agostino A, Barberio M (2003) Pancreaticoduodenectomy in portal hypertension: use of the LigaSure. J Hepatobiliary Pancreat Surg 10(3):215–217PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Paolo Limongelli
    • 1
  • Andrea Belli
    • 1
  • Gianluca Russo
    • 1
  • Luigi Cioffi
    • 1
  • Alberto D’Agostino
    • 1
  • Corrado Fantini
    • 1
  • Giulio Belli
    • 1
    • 2
  1. 1.Department of General and Hepato-Pancreato-Biliary SurgeryS.M. Loreto Nuovo HospitalNaplesItaly
  2. 2.NaplesItaly

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