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Langenbeck's Archives of Surgery

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Open Access 07-02-2022 | Pancreatectomy | Original Article

Converted laparoscopic distal pancreatectomy: is there an impact on patient outcome and total cost?

Authors: Riccardo Casadei, Carlo Ingaldi, Claudio Ricci, Emilio De Raffele, Laura Alberici, Francesco Minni

Published in: Langenbeck's Archives of Surgery | Issue 4/2022

Abstract

Purpose

Recent studies have reported worse outcomes of converted laparoscopic distal pancreatectomy (CLDP) with respect to total laparoscopic (TLDP) and open (ODP). The aim of the study was to evaluate the impact of conversion on patient outcome and on total cost.

Methods

Patients requiring a conversion (CLDP) were compared with both TLDP and ODP patients. The relevant patient- and tumour-related variables were collected for each patient. Both intra and postoperative data were extracted. Propensity score matching (PSM) analysis was carried out to equate the groups compared.

Results

Two hundred and five patients underwent DP, 105 (51.2%) ODPs, 81 (39.5%) TLDPs, and 19 (9.3%) CLDPs. After PSM, 19 CLDPs, 38 TLDPs, and 38 ODPs were compared. Patients who underwent CLDP showed a significantly longer operative time (P < 0.001), and an increase in blood loss (P = 0.032) and total cost (P = 0.034) with respect to TLDP, and a significantly longer operative time (P < 0.001), less frequent postoperative morbidity (P = 0.050), and a higher readmission rate (P = 0.035) with respect to ODP.

Conclusion

Total laparoscopic pancreatectomy was superior regarding operative findings and total costs with respect to CLDP; ODP showed a higher postoperative morbidity rate and a lower readmission rate with respect to CLDP. However, the reasons for the readmission of patients who underwent CLDP were mainly related to postoperative pancreatic fistula (POPF) grade B which is usually due to pancreas texture. Thus, the majority of distal pancreatectomies can be started using a minimally invasive approach, performing an early conversion if necessary.

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Title: Converted laparoscopic distal pancreatectomy: is there an impact on patient outcome and total cost?
Authors: Riccardo Casadei
Carlo Ingaldi
Claudio Ricci
Emilio De Raffele
Laura Alberici
Francesco Minni
Publication date: 07-02-2022
Publisher: Springer Berlin Heidelberg
Keyword: Pancreatectomy
Published in: Langenbeck's Archives of Surgery / Issue 4/2022
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-021-02427-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Converted laparoscopic distal pancreatectomy: is there an impact on patient outcome and total cost?

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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