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

Background: Previous studies comparing open distal pancreatectomy (ODP) and laparoscopic distal pancreatectomy (LDP) have found advantages related to minimalaccess 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. Methods: A retrospective analysis of a prospectively maintained database of 52 distal pancreatic resections that were performed during a 10-year period was performed. Results: 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). Conclusions: Laparoscopic distal pancreatectomy for leftsided 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.