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

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 pound (range, 4276- pound 9500) pound, 4547 pound (range, 1299- pound 13937) pound, 10587 pound (range, 6508- pound 20303) pound vs. 5231 pound (range, 3409- pound 9330) pound, 10094 pound (range, 2665- pound 39291) pound, 15324 pound (range, 7209- pound 47484) pound 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.