Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study

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Abstract
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). 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. 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). 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.