title: Laparoscopic Distal Pancreatectomy in Benign or Premalignant Pancreatic Lesions: Is It Really More Cost-Effective than Open Approach?
abstract: BACKGROUND
  Data regarding the quality of life in patients undergoing laparoscopic distal pancreatectomy are lacking and no studies have reported a real cost-effectiveness analysis of this surgical procedure. The aim of this study was to evaluate and compare the quality of life and the cost-effectiveness of a laparoscopic distal pancreatectomy with respect to an open distal pancreatectomy.
  
  
  METHODS
  Forty-one patients who underwent a laparoscopic distal pancreatectomy and 40 patients who underwent an open distal pancreatectomy were retrospectively studied as regards postoperative results, quality of life and cost-effectiveness analysis. The Italian neutral version of the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C-30, version 3.0, was used to rate the quality of life.
  
  
  RESULTS
  Postoperative results were similar in the two groups; the only difference was that the first oral intake took place significantly earlier in the laparoscopic group than in the open group (P < 0.001). Regarding quality of life, the laparoscopic approach was able to ameliorate physical functioning (P = 0.049), role functioning (P = 0.044) and cognitive functioning (P = 0.030) and reduce the sleep disturbance scale (P = 0.050). The cost-effectiveness analysis showed that the acceptability curve for a laparoscopic distal pancreatectomy had a higher probability of being more cost-effective than an open distal pancreatectomy when a willingness to pay above 5400 Euros/quality-adjusted life years (QALY) was accepted.
  
  
  CONCLUSIONS
  Despite the limitations of the study, laparoscopic distal pancreatectomy can be considered not only safe and feasible but also permits a better quality of life and is acceptable in terms of cost-effectiveness to Italian and European health care services.
authors.affiliation: Department of Medical and Surgical Sciences-DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Via Massarenti n.9, 40138, Bologna, Italy, claudiochir@gmail.com.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ricci
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casadei
authors.forename: Giovanni
authors.initials: G
authors.lastname: Taffurelli
authors.forename: Selene
authors.initials: S
authors.lastname: Bogoni
authors.forename: Marielda
authors.initials: M
authors.lastname: D'Ambra
authors.forename: Carlo
authors.initials: C
authors.lastname: Ingaldi
authors.forename: Nico
authors.initials: N
authors.lastname: Pagano
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Pacilio
authors.forename: Francesco
authors.initials: F
authors.lastname: Minni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000191:economics* / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D055815:Young Adult