title: Results of 100 consecutive laparoscopic distal pancreatectomies: postoperative outcome, cost-benefit analysis, and quality of life assessment.
abstract: BACKGROUND
  Laparoscopic distal pancreatectomy (LDP) has been recently proposed as the procedure of choice for lesions of the pancreatic body and tail in experienced centres. The purpose of this study is to assess the potential advantages of LDP in a consecutive series of 100 patients.
  
  
  METHODS
  Propensity score matching was used to identify patients for comparison between LDP and control open group. Match criteria were: age, gender, ASA score, BMI, lesion site and size, and malignancy. All patients were treated according to an early feeding recovery policy. Primary endpoint was postoperative morbidity rate. Secondary endpoints were operative time, blood transfusion, length of hospital stay (LOS), hospital costs, and quality of life.
  
  
  RESULTS
  Thirty patients of the LDP group had pancreatic adenocarcinoma. Conversion to open surgery was necessary in 23 patients. Mean operative time was 29 min shorter in the open group (p = 0.002). No significant difference between groups was found in blood transfusion rate and postoperative morbidity rate. LDP was associated with an early postoperative rehabilitation and a shorter LOS in uneventful patients. Economic analysis showed <euro> 775 extra cost per patient of the LDP group. General health perception and vitality were better in the LDP group one month after surgery.
  
  
  CONCLUSIONS
  Laparoscopic distal pancreatectomy improved short-term postoperative recovery and quality of life in a consecutive series of both cancer and non-cancer patients. Despite the extra cost, the laparoscopic approach should be considered the first option in patients undergoing distal pancreatectomy.
authors.affiliation: Department of Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy, braga.marco@hsr.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
authors.forename: Nicolò
authors.initials: N
authors.lastname: Pecorelli
authors.forename: Denise
authors.initials: D
authors.lastname: Ferrari
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Balzano
authors.forename: Walter
authors.initials: W
authors.lastname: Zuliani
authors.forename: Renato
authors.initials: R
authors.lastname: Castoldi
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D061887:Conversion to Open Surgery; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010180:Pancreatectomy / Q000191:economics* / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery; D011183:Postoperative Complications; D057216:Propensity Score; D011788:Quality of Life