Article

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

Department of General and Hepato-Pancreato-Biliary Surgery, S.M. Loreto Nuovo Hospital, Via A. Vespucci, 80142 Naples, Italy.
Surgical Endoscopy (Impact Factor: 3.31). 01/2012; 26(7):1830-6. DOI: 10.1007/s00464-011-2141-z
Source: PubMed

ABSTRACT 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.

0 Followers
 · 
200 Views
  • Source
    • "Two meta-analyses [23,25] demonstrated increased splenic preservation by the laparoscopic approach with oncological margins equivalent in two studies [22] [24]. In terms of cost, LDP is at least comparable with or without re-admission included in the cost comparison [16] [33] and in some studies the cost is reportedly less [29] [34]. Fig. 2. The position of ports for an easy pancreato-duodenectomy. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic surgery was reported as early as 1898. Since then significant developments have been made in the field of pancreatic resections. In addition, advances in laparoscopic surgery in general have seen the description of this approach in pancreatic surgery with increasing frequency. Although there are no randomized controlled trials, several large series and comparative studies have reported on the short and long term outcome of laparoscopic pancreatic surgery. Furthermore, in the last decade published systematic reviews and meta-analyses have reported on cost effectiveness and outcomes of these procedures.
    Best practice & research. Clinical gastroenterology 02/2014; 28(1):123-132. DOI:10.1016/j.bpg.2013.11.011 · 3.28 Impact Factor
  • Source
    • "Two meta-analyses [23,25] demonstrated increased splenic preservation by the laparoscopic approach with oncological margins equivalent in two studies [22] [24]. In terms of cost, LDP is at least comparable with or without re-admission included in the cost comparison [16] [33] and in some studies the cost is reportedly less [29] [34]. Fig. 2. The position of ports for an easy pancreato-duodenectomy. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic surgery was reported as early as 1898. Since then significant developments have been made in the field of pancreatic resections. In addition, advances in laparoscopic surgery in general have seen the description of this approach in pancreatic surgery with increasing frequency. Although there are no randomized controlled trials, several large series and comparative studies have reported on the short and long term outcome of laparoscopic pancreatic surgery. Furthermore, in the last decade published systematic reviews and meta-analyses have reported on cost effectiveness and outcomes of these procedures.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives:  Currently, laparoscopic distal pancreatectomy (LDP) is regarded as a safe and effective surgical approach for lesions in the body and tail of the pancreas. This review compares outcomes of the laparoscopic technique with those of open distal pancreatectomy (ODP) and assesses the efficacy, safety and feasibility of each type of procedure. Methods:  Comparative studies published between January 1996 and April 2012 were included. Studies were selected based on specific inclusion and exclusion criteria. Evaluated endpoints were operative outcomes, postoperative recovery and postoperative complications. Results:  Fifteen non-randomized comparative studies that recruited a total of 1456 patients were analysed. Rates of conversion from LDP to open surgery ranged from 0% to 30%. Patients undergoing LDP had less intraoperative blood loss [weighted mean difference (WMD) -263.36.59 ml, 95% confidence interval (CI) -330.48 to -196.23 ml], fewer blood transfusions [odds ratio (OR) 0.28, 95% CI 0.11-0.76], shorter hospital stay (WMD -4.98 days, 95% CI -7.04 to -2.92 days), a higher rate of splenic preservation (OR 2.98, 95% CI 2.18-3.91), earlier oral intake (WMD -2.63 days, 95% CI -4.23 to 1.03 days) and fewer surgical site infections (OR 0.37, 95% CI 0.18-0.75). However, there were no differences between the two approaches with regard to operation time, time to first flatus and the occurrence of pancreatic fistula and other postoperative complications. Conclusions:  Laparoscopic resection results in improved operative and postoperative outcomes compared with open surgery according to the results of the present meta-analyses. It may be a safe and feasible option for patients with lesions in the body and tail of the pancreas. However, randomized controlled trials should be undertaken to confirm the relevance of these early findings.
    HPB 11/2012; 14(11):711-24. DOI:10.1111/j.1477-2574.2012.00531.x · 2.05 Impact Factor
Show more