title: Laparoscopic and open surgical treatment of left-sided pancreatic lesions: clinical outcomes and cost-effectiveness analysis.
abstract: BACKGROUND
  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.
  
  
  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 (<euro>2889 vs. <euro>1989; P < 0.0001). The entire cost of the associated hospital stay was higher in the ODP group (<euro>8955 vs. <euro>6714; P < 0.043). The total cost was comparable in LDP and ODP groups (<euro>9603 vs. <euro>10944; P = 0.204).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General and Hepato-Pancreato-Biliary Surgery, S.M. Loreto Nuovo Hospital, Via A. Vespucci, 80142 Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Limongelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Belli
authors.forename: Gianluca
authors.initials: G
authors.lastname: Russo
authors.forename: Luigi
authors.initials: L
authors.lastname: Cioffi
authors.forename: Alberto
authors.initials: A
authors.lastname: D'Agostino
authors.forename: Corrado
authors.initials: C
authors.lastname: Fantini
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000191:economics* / Q000379:methods; D010182:Pancreatic Diseases / Q000191:economics / Q000601:surgery*; D010185:Pancreatic Fistula / Q000191:economics / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000191:economics / Q000601:surgery; D010195:Pancreatitis / Q000191:economics / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D013156:Splenectomy / Q000191:economics / Q000379:methods; D013530:Surgical Wound Infection / Q000191:economics; D016896:Treatment Outcome