Which method of distal pancreatectomy is cost-effective among open, laparoscopic, or robotic surgery?

Abstract:

Background:The aim of this study was to analyze the clinical and economic impact of robotic distal pancreatectomy, laparoscopic distal pancreatectomy, and open distal pancreatectomy. Methods:All consecutive patients who underwent distal pancreatic resection for benign and malignant diseases between January 2012 and December 2015 were prospectively included. Cost analysis was performed; all charges from patient admission to discharge were considered. Results:There were 21 robotic (RDP), 25 laparoscopic (LDP), and 43 open (ODP) procedures. Operative time was longer in the RDP group (RDP =345 minutes, LDP =306 min, ODP =251 min, P=0.01). Blood loss was higher in the ODP group (RDP =192 mL, LDP =356 mL, ODP =573 mL, P=0.0002). Spleen preservation was more frequent in the RDP group (RDP =66.6%, LDP =61.9%, ODP =9.3%, P=0.001). The rate of patients with Clavien-Dindo > grade III was higher in the ODP group (RDP =0%, LDP =12%, ODP =23%, P=0.01), especially for non-surgical complications, which were more frequent in the ODP group (RDP =9.5%, LDP =24%, ODP =41.8%, P=0.02). Length of hospital stay was increased in the ODP group (ODP =19 days, LDP =13 days, RDP =11 days, P=0.007). The total cost of the procedure, including the surgical procedure and postoperative course was higher in the ODP group (ODP =30,929 Euros, LDP =22,150 Euros, RDP =21,219 Euros, P=0.02). Conclusions:Cost-effective results of RDP seem to be similar to LDP with some better short-term outcomes.

authors

Rodriguez M,Memeo R,Leon P,Panaro F,Tzedakis S,Perotto O,Varatharajah S,de'Angelis N,Riva P,Mutter D,Navarro F,Marescaux J,Pessaux P

doi

10.21037/hbsn.2018.09.03

subject

Has Abstract

pub_date

2018-10-01 00:00:00

pages

345-352

issue

5

eissn

2304-3881

issn

2304-389X

pii

hbsn-07-05-345

journal_volume

7

pub_type

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