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01-07-2012

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

Authors: Paolo Limongelli, Andrea Belli, Gianluca Russo, Luigi Cioffi, Alberto D’Agostino, Corrado Fantini, Giulio Belli

Published in: Surgical Endoscopy | Issue 7/2012

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 (€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 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.

John TG, Greig JD, Carter DC, Garden OJ (1995) Carcinoma of the pancreatic head and periampullary region: tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg 221:156–164PubMedCrossRef

Takaori K, Tanigawa N (2007) Laparoscopic pancreatic resection: the past, present, and future. Surg Today 37:535–545PubMedCrossRef

Sa Cunha A, Rault A, Beau C, Laurent C, Collet D, Masson B (2008) A single-institution prospective study of laparoscopic pancreatic resection. Arch Surg 143:289–295PubMedCrossRef

Briggs CD, Mann CD, Irving GR, Neal CP, Peterson M, Cameron IC, Berry DP (2009) Systematic review of minimally invasive pancreatic resection. J Gastrointest Surg 13:1129–1137PubMedCrossRef

Baker MS, Bentrem DJ, Ujiki MB, Stocker S, Talamonti MS (2009) A prospective single-institution comparison of perioperative outcomes for laparoscopic and open distal pancreatectomy. Surgery 146:635–643PubMedCrossRef

Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin RC II, Scoggins CR, Ahmad S, Kim HJ, Park J, Johnston F, Strouch MJ, Menze A, Rymer J, McClaine R, Strasberg SM, Talamonti MS, Staley CA, McMasters KM, Lowy AM, Byrd-Sellers J, Wood WC, Hawkins WG (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248:438–446PubMed

DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244:931–937 discussion 937–939PubMedCrossRef

Bassi C, Dervenis MK, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRef

Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120:1051–1054PubMedCrossRef

10.

Mabrut J-Y, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF; Hepatobiliary and Pancreatic Section (HBPS) of the Royal Belgian Society of Surgery; Belgian Group for Endoscopic Surgery (BGES); Club Coelio (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137:597–605

11.

Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 246:77–82PubMedCrossRef

12.

Belli G, Limongelli P, Fantini C, D’Agostino A, Cioffi L, Belli A, Russo G (2009) Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 96:1041–1048PubMedCrossRef

13.

Knaebel HP, Diener MK, Wente MN, Büchler MW, Seiler CM (2005) Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 92:539–546PubMedCrossRef

14.

Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch OR, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Büchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377(9776):1514–1522PubMedCrossRef

15.

Weber SM, Cho CS, Merchant N, Pinchot S, Rettammel R, Nakeeb A, Bentrem D, Parikh A, Mazo AE, Martin RC III, Scoggins CR, Ahmad SA, Kim HJ, Hamilton N, Hawkins W, Max Schmidt C, Kooby DA (2009) Laparoscopic left pancreatectomy: complication risk score correlates with morbidity and risk for pancreatic fistula. Ann Surg Oncol 16(10):2825–2833PubMedCrossRef

16.

Cho CS, Kooby DA, Schmidt CM, Nakeeb A, Bentrem DJ, Merchant NB, Parikh AA, Martin RC II, Scoggins CR, Ahmad SA, Kim HJ, Hamilton N, Hawkins WG, Weber SM (2011) Laparoscopic versus open left pancreatectomy: can preoperative factors indicate the safer technique? Ann Surg 253(5):975–980PubMedCrossRef

17.

Jayaraman S, Gonen M, Brennan MF, D’Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR, Allen PJ (2010) Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. J Am Coll Surg 211(4):503–509PubMedCrossRef

18.

Matsumoto T, Shibata K, Ohta M, Iwaki K, Uchida H, Yada K, Mori M, Kitano S (2008) Laparoscopic distal pancreatectomy and open distal pancreatectomy: a nonrandomized comparative study. Surg Laparosc Endosc Percutan Tech 18:340–343PubMedCrossRef

19.

Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW, Lee SK, Kim MH, Han DJ (2008) Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 22:2261–2268PubMedCrossRef

20.

Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW (2008) Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc 2:1334–1338CrossRef

21.

Nigri GR, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, Ramacciato G, Melis M (2011) Meta-analysis of trials comparing minimally invasive and open distal pancreatectomies. Surg Endosc 25(5):1642–1651 Epub 2010 Dec 24PubMedCrossRef

22.

Baker MS, Bentrem DJ, Ujiki MB, Stocker S, Talamonti MS (2011) Adding days spent in readmission to the initial postoperative length of stay limits the perceived benefit of laparoscopic distal pancreatectomy when compared with open distal pancreatectomy. Am J Surg 201(3):295–299 discussion 299-300PubMedCrossRef

23.

Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192PubMedCrossRef

24.

Liang JT, Huang KC, Lai HS, Lee PH, Jeng YM (2007) Oncologic results of laparoscopic versus conventional open surgery for stage II and III left-sided colon cancers: a randomized controlled trial. Ann Surg Oncol 14:109–117PubMedCrossRef

25.

Belli G, Fantini C, Ciciliano F, D’Agostino A, Barberio M (2003) Pancreaticoduodenectomy in portal hypertension: use of the LigaSure. J Hepatobiliary Pancreat Surg 10(3):215–217PubMedCrossRef

Title: Laparoscopic and open surgical treatment of left-sided pancreatic lesions: clinical outcomes and cost-effectiveness analysis
Authors: Paolo Limongelli
Andrea Belli
Gianluca Russo
Luigi Cioffi
Alberto D’Agostino
Corrado Fantini
Giulio Belli
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 7/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-011-2141-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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