Open Distal Pancreatectomy Research Articles

Identifying Hospital Cost Savings Opportunities by Optimizing Surgical Approach for Distal Pancreatectomy

BackgroundThe economic implications of relevant clinicopathologic factors on the surgical approach to distal pancreatectomy (DP) should be clearly defined and understood to potentially allow the implementation of cost reduction strategies. MethodsAdministrative and clinical datasets of patients undergoing a DP between 2012 and 2016 were merged and queried. Univariate and multivariate analyses were used to identify clinicopathologic predictors of cost differentials for minimally invasive DP (MIDP) relative to open DP (ODP). Time trends in cost were also assessed to identify opportunities for cost containment. ResultsAmong two hundred and twenty five patients, 128 underwent an ODP (57%) and 97 a MIDP (43%). The DP groups were comparable with regard to relevant perioperative and disease characteristics. Total hospitalization and total OR costs for MIDP were significantly lower (− 12%, P = 0.0048) and higher (+ 16%, P < 0.0001) respectively, compared to ODP. On univariate analysis, age > 60 (− 12%, P = 0.0262), BMI > 25 (− 10%, P = 0.0222), ASA class ≥ 3 (− 11%, P = 0.0045), OpTime > 230 min (− 16%, P = 0.0004), and T stage ≥ 3 (− 8%, P = 0.0452) were associated with decreased total costs after MIDP compared to ODP. Linear regression analysis revealed that BMI > 25 (Estimate − 0.31, SE 0.15, P = 0.0482), ASA class ≥ 3 (Estimate − 0.36, SE 0.17, P = 0.0344), and T stage ≥ 3 (Estimate − 0.57, SE 0.26, P = 0.0320) were associated with decreased hospitalization costs after MIDP compared to ODP. Overtime, total hospitalization cost for MIDP increased from − 21 to 1% (P = 0.0197), while OR costs for MIDP decreased from + 41% to − 2% (P = 0.0049), nearly equalizing the cost differences between ODP and MIDP. ConclusionsRelevant clinicopathologic factors predicted decreased hospitalization costs after MIDP relative to ODP. In equivalent stages of disease, optimizing the surgical approach to DP based on specific clinicopathologic characteristics may afford significant cost-saving opportunities.

Short-term outcomes in open and laparoscopic distal pancreatectomy in a national cohort study

Introduction: Distal pancreatectomy (DP) is increasingly performed by laparoscopy yet outcomes reported from unselected routine practice are scarce. We describe outcomes of laparoscopic and open DP in a complete cohort. Methods: A national cohort of all patients undergoing DP in a universal health care system (2012-2016) from the Norwegian Patient Register. Short-term outcomes for evaluation include aggregated length of stay (aLOS) and rates of reoperation, readmissions and mortality (90 days). Risk is reported as odds ratio with 95% confidence interval (OR, 95% CI). Results: Of 546 procedures, 323 (59%) were laparoscopic. DP rate increased during period. Median age was 66 years (IQR 55-72), with 52% being female (Table 1). Women (OR 1.43, 95% c.i. 1.02-2.02; P=0.039) and patients with higher Charlson comorbidity score (OR 0.56, 95% c.i. 0.32-0.99; P=0.045) were significantly more often selected to open DP. The majority of DPs were done for pancreatic tumours (n=258, 47%), of which 166 were done laparoscopic (64%). A splenectomy was included in 416 (76%) of all DPs, with no difference between open or laparoscopy groups. Reoperation rate at 30 days was 5.7% (n=31), with 4.3% for laparoscopic (n=14) and 7.6% for open DP (n=17). The median aLOS was 5.5 days shorter in laparoscopic to open DP (median 8.6 days vs 14.1; P< 0.001). Readmission rate was 20%, 90-day mortality was 1.1%. Conclusion: Laparoscopy is becoming the preferred access in a routine nationwide practice with reduction in length of stay but otherwise no difference in short-term outcomes. Readmission rate is high after DPs.Tabled 1FP15-06 Table 1VariableTotalOpen DPLap. DPPOR (95% CI)N=546N=223 (41%)N=323 (59%)Female, n (%) Male, n (%)284(52%) 264(48%)127 (57%) 96 (43%)155 (48%) 168 (52%).0391.43 (1.02-2.02)Age <65 yrs (n, %)255 (47%)104 (47%)151 (47%).9790.99 (0.71-1.40)Comorb. CCI >1 (n, %)52 (10%)28 (13%)24 (7%).0450.56 (0.32-0.99)Splenectomy, n (%)416 (76%)177 (79%)239 (74%).1470.74 (0.49-1.11Outcomes aLoS (median, iqr)9 (5-14)12 (8-19)7 (5-11)<.001n.a.Reoperations (n, %)31 (6%)17 (8%)14 (4%).1030.55 (0.27-1.14)Readmissions (n, %)107 (20%)42 (19%)65 (20%).7091.09 (0.71-1.67)Mortality 90-d, n (%)6 (1.1%)2 (0.9%)4 (1.2%).7071.39 (0.25-7.63) Open table in a new tab

A novel technique for pancreatic stump closure following distal pancreatectomy – The CLASP technique

Introduction: Pancreatic fistula (PF) remains the primary source of morbidity following distal pancreatectomy (DP). There is currently no optimal stump closure technique to reduce pancreatic fistula rates. Methods: Presentation of a novel technique for pancreatic stump closure using Clip Ligation of the duct and Associated Suturing of Pancreas (CLASP). Retrospective study of the clinicopathological data and outcome of five patients that underwent distal pancreatectomy and splenectomy (DPS) using the CLASP technique. Results: Five patients with a median age of 65 underwent distal pancreatectomy splenectomy for pancreatic body or tail tumour using the CLASP technique. Four of those operations were done laparoscopically. Only one patient developed grade A PF. No other postoperative complications were noticed. The mean length of stay was 5.4 days. CLASP technique was applicable in both laparoscopic and open distal pancreatectomy. It is a useful alternative technique to the current traditional methods, especially in the cases of bulky pancreas and very proximal tumours located at the neck of pancreas. In the short video we demonstrate the steps of the laparoscopic DP including mobilisation of the pancreatic body from the retroperitoneum, division of the parenchyma with energy device isolating the pancreatic duct (PD), application of a double ligaclip on the proximal duct, division of the PD and finally suturing of the pancreatic stump. Conclusions: CLASP technique is an effective, reproducible, cheap and safe alternative technique, particularly for bulky pancreas, that could be compared to the traditional methods of pancreatic stump closure.

Minimally invasive vs. open distal pancreatectomy (LEOPARD): multicenter patient-blinded randomized controlled trial

Minimally invasive vs. open distal pancreatectomy (LEOPARD): multicenter patient-blinded randomized controlled trial

Laparoscopic distal pancreatectomy: which factors are related to open conversion? Lessons learned from 68 consecutive procedures in a high volume pancreatic center

Background: Laparoscopic distal pancreatectomy represents a difficult surgical procedure with an high conversion rate to open procedure. The factors related to its difficulty and to conversion to open distal pancreatectomy were rarely reported. The aim of the present study was to identify which factors are related to conversion from laparoscopic to open distal pancreatectomy. Methods: A retrospective study of a prospective database of 68 patients who underwent laparoscopic distal pancreatectomy was conducted at a high-volume center by pancreatic surgeons experienced with laparoscopic surgery. Pre-intra and postoperative data were collected. Patients who completed a laparoscopic distal pancreatectomy were compared with those who needed a conversion to the open approach as regards demographic, clinical, radiological and surgical data. Univariate and multivariate analyses were carried out. Results: Univariate analysis suggested that the site of the lesion, the extension of pancreatic resection and the requirement for an extended procedure to adjacent organs were significantly associated with the risk of conversion to the open approach. Multivariate analysis showed that only the extension of the pancreatic resection (subtotal pancreatectomy) was significantly related to the odds of conversion (odds ratio (OR) 19.5; 95% confidence interval (CI) 1.1-32.3; P=0.038). Preoperative suspicion of malignancy differed between the two groups; however, this difference did not reach statistical significance (P=0.078). Conclusions: Despite the limitations of the study, only the extension of pancreatic resection seemed to be the main factor related to conversion during laparoscopic distal pancreatectomy.

Postoperative complications of distal pancreatectomy in a high volume centre for pancreatic resections in the Czech Republic

Introduction: The goal of this study was to investigate whether the method of closure of the pancreatic remnant effects the incidence of postoperative complications in distal pancreatectomy. Methods: Hospital records of the department of surgery of the Royal Vinohrady University Hospital were reviewed for all open distal pancreatectomies performed between the years 2011 and 2017. Patient, surgical and histopatological characteristics were collected and analysed. Cases were the pancreatic resection surface was closed by suture closure and pancreatic duct ligation alone were compared with cases where the resection surface was additionally covered by hemostatic agents. The outcome measure was the incidence of postoperative complications. Results: In total 73 patients were included into the study. Postoperative complications consisted of pancreatic fistula (n = 17), postoperative hemorrhage (n = 3) and organ/space surgical site infection (n = 7). According to the classification of the International Study Group of Pancreatic Surgery ten fistulae were grade A and seven were grade C. Conclusion: Our study shows a lower incidence of pancreatic fistula in cases where the pancreatic duct was ligated and the resection surface was covered by the hemostatic patch Veriset.

Splenic vein resection together with the pancreatic parenchyma versus separated resection after isolation of the parenchyma during distal pancreatectomy (COSMOS-DP trial): study protocol for a randomised controlled trial

BackgroundIn distal pancreatectomy (DP), it is customary to ligate and divide the splenic vein after isolating it from the pancreatic parenchyma. This is considered essential to prevent disruption of the stump of the splenic vein and consequent intra-abdominal haemorrhage in the event of pancreatic fistula (PF). However, this procedure can be technically demanding, especially when the vein is firmly embedded in the pancreatic parenchyma. The objective of the COSMOS-DP trial is to confirm the non-inferiority of resection of the splenic vein embedded in the pancreatic parenchyma compared with the conventional technique of isolating the splenic vein before resection during DP using a mechanical stapler.MethodsPatients with diseases of the pancreatic body and tail whose pancreatic parenchyma and splenic vein can be divided concurrently during open or laparoscopic DP are considered eligible for inclusion. This study is designed as a multicentre prospective randomised phase III trial. Eligible patients will be centrally randomised to either Arm A (resection of the splenic vein after isolation from the pancreatic parenchyma) or Arm B (co-resection of the vein together with the pancreas). This study aims to establish the non-inferiority of the safety of Arm B compared with that of Arm A; the primary endpoint is the incidence of PF (ISGPF grade B/C).DiscussionThe COSMOS-DP trial will establish the safety of this procedure, such that it can be recommended with more confidence. The use of this procedure will likely result in significant reductions in operative time and blood loss during DP.Trial registrationClinicalTrials.gov, NCT02871804. Registered on 27 July 2016.

Laparoscopic distal pancreatectomy: better than open?

Distal pancreatectomy is well suited to the laparoscopic approach. Laparoscopic distal pancreatectomy (LDP) provides the same postoperative recovery advantages reputed to minimal access surgery. However, there have been fears as to the safety of LDP in terms of life-threatening intra-operative events and post-operative complications, adequate carcinological outcomes as compared to traditional (open) distal pancreatectomy (ODP) when performed for cancer, as well as to whether the laparoscopic approach is well adapted to the variety of diseases that may affect the pancreas (ranging from trauma to benign or malignant disease) and whether the minimal access approach is well adapted to perform pancreatic surgery safely in the obese, the elderly or the frail. In this review of the literature, we sought to determine whether LDP was as safe, provided the same oncological outcomes and was applicable to all diseases involving the body and tail of the pancreas, and to particular patient characteristics, compared to the traditional open approach. Last we looked at cost issues. We concluded that this review of the literature allowed to state that laparoscopic distal pancreatectomy is feasible and safe for a wide range of diseases, both benign and malignant. Morbidity, mortality, and probably, also, carcinological outcomes are comparable to open surgery. The overall costs are similar but the advantages of minimal access surgery make it the preferred approach, once the surgical expertise is acquired and present.

Laparoscopic versus open distal pancreatectomy for left-sided pancreatic cancer: A stage adjusted survival analysis according to the 8th edition AJCC staging

Laparoscopic versus open distal pancreatectomy for left-sided pancreatic cancer: A stage adjusted survival analysis according to the 8th edition AJCC staging

Laparoscopic versus open distal pancreatectomy – results of a single-center group of 346 patients

Laparoscopic versus open distal pancreatectomy – results of a single-center group of 346 patients

International validation of the updated international study group of pancreatic surgery definition of postoperative pancreatic fistula after distal pancreatectomy

Background: Postoperative pancreatic fistula (POPF) remains the most common complication after distal pancreatectomy (DP). The International Study Group of Pancreatic Surgery (ISGPS) recently updated their POPF definition. This study aimed to validate the updated definition in patients after DP. Methods: In this international retrospective cohort study, performed in 5 centers on patients after DP from 2005 to 2016, main focus was the effect of discarding grade A and the change of POPF grade B by comparing the distribution of complications amongst POPF grades according to the old (2005) and updated (2016) definitions. Results: In total, 1089 patients were included. The incidence of POPF grade B/C decreased with the updated definition (355(33%) vs 260(24%) <0.01), mostly because of less POPF grade B (328(30%) vs 234(21%) <0.01). The rate of POPF grade C was comparable for the old and updated definition (27(2%) vs 26(2%) >0.99). The old no POPF group was comparable regarding distribution of complications with the updated no POPF group (including biochemical leak) (Clavien-Dindo ≥3 29(5%) vs 46(6%) = 0.32, ICU 15(3%) vs 20(2%) = 0.6 and hospital stay 7(6–9) vs 7(6–9) = 0.30). In patients with a POPF grade B according to the updated definition more Clavien-Dindo ≥3 complications (124(38%) vs 119(51%) <0.01) and longer hospital stay (9(9–13) vs 9(7–15) <0.01) were seen. The rate of ICU admissions amongst POPF grade B patients was comparable (10(3%) vs 9(4%) = 0.25). The decrease in POPF grade B/C with the updated definition was similar in minimally invasive (149 (42%) vs 101(39%)) and open DP (206(58%) vs 159(61%)) (=0.05). Conclusion: The updated 2016 ISGPS POPF definition showed an improvement in the ability to discriminate between patients with and without a (clinically relevant) POPF after DP. This improvement was present in both minimally invasive and open DP.

Minimally invasive versus open distal pancreatectomy (leopard): Multicenter patient-blinded randomized controlled trial

Minimally invasive versus open distal pancreatectomy (leopard): Multicenter patient-blinded randomized controlled trial

Splenic vessel patency: is it real menace to perform laparoscopic splenic vessel-preserving distal pancreatectomy.

PurposeThis study compared the patency of the splenic vessels between laparoscopic and open spleen and splenic vessel-preserving distal pancreatectomy.MethodsWe retrospectively reviewed a database of 137 patients who underwent laparoscopic (n = 91) or open (n = 46) spleen and splenic vessel-preserving distal pancreatectomy at a single institute from 2001 through 2015. Splenic vessel patency was assessed by abdominal computed tomography and classified into three grades according to the degree of stenosis.ResultsThe splenic artery patency rate was similar in both groups (97.8 vs. 95.7%, P = 0.779). Also, the splenic vein patency rate was not significantly different between the 2 groups (74.7% vs. 82.6%, P = 0.521). Postoperative wound complication was significantly lower in the laparoscopic group (19.8% vs. 28.3%, P = 0.006), and hospital stay was significantly shorter in the laparoscopic group (7 days vs. 9 days, P = 0.001) than in the open group. Median follow-up periods were 22 months (3.7–96.2 months) and 31.7 months (4–104 months) in the laparoscopic and open groups, respectively.ConclusionLaparoscopic distal pancreatectomy showed good splenic vessel patency as well as open distal pancreatectomy. For this reason, splenic vessel patency is not an obstacle in performing laparoscopic splenic vessel-preserving distal pancreatectomy.

Laparoscopic distal pancreatectomy: which factors are related to open conversion? Lessons learned from 68 consecutive procedures in a high-volume pancreatic center.

Laparoscopic distal pancreatectomy represents a difficult surgical procedure with an high conversion rate to open procedure. The factors related to its difficulty and conversion to open distal pancreatectomy were rarely reported. The aim of the present study was to identify which factors are related to conversion from laparoscopic to open distal pancreatectomy. A retrospective study of a prospective database of 68 patients who underwent laparoscopic distal pancreatectomy was conducted at a high-volume center by pancreatic surgeons experienced with laparoscopic surgery. Pre-intra and postoperative data were collected. Patients who completed a laparoscopic distal pancreatectomy were compared with those who needed a conversion to the open approach as regard demographic, clinical, radiological, and surgical data. Univariate and multivariate analyses were carried out. Univariate analysis suggested that the site of the lesion, the extension of pancreatic resection, and the requirement for an extended procedure to adjacent organs were significantly associated with the risk of conversion to the open approach. Multivariate analysis showed that only the extension of the pancreatic resection (subtotal pancreatectomy) was significantly related to the odds of conversion [odds ratio (OR) 19.5; 95% confidence interval (CI) 1.1-32.3; P = 0.038]. Preoperative suspicion of malignancy differed between the two groups; however, this difference did not reach statistical significance (P = 0.078). Despite the limitations of the study, only the extension of pancreatic resection seemed to be the main factor related to conversion during laparoscopic distal pancreatectomy.

Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA)-a difficult question to answer.

Since the introduction of laparoscopy as an adjunct to abdominal surgery in the 1980’s, surgeons have sought to compare the clinical outcomes of minimally invasive procedures with their parent operations.

The role of laparoscopic distal pancreatectomy in elderly patients.

Minimally invasive surgery has gained wide acceptance in many institutions. Complex surgery such as pancreatic resections delayed its diffusion due to high rate postoperative complications and technical aspects, while for pancreaticoduodenctomy the role of a minimally invasive approach is still on debate. Laparoscopic distal pancreatectomy may be considered a safe procedure and a valid alternative in selected cases. The operating time, learning curve and the costs represent major drawbacks for the laparoscopic approach. Elderly patients (>70 years of age) are generally considered to be at higher risk for developing complications after pancreatic surgery due to compromised physiological reserve and presence of multiple comorbidities. Our aim was to make a review about the role of laparoscopic distal pancreatectomy (LDP) in the elderly population. A systematic search of the scientific literature was performed using PubMed, EMBASE, online journals, and the Internet for all publications on LDP and open distal pancreatectomy (ODP) in old age patients. All selected articles were reviewed and analyzed. We found 393 abstract that were reviewed. We considered all type of publications. Laparoscopic pancreatic resections are considered more difficult due to the retroperitoneal organ location and by the presence of surrounding large vessels and other crucial structures. Therefore, an adequate learning curve is needed. Beyond these remarks, in many institutions, LDP is a standard approach in patients with lesions in the body and tail of the pancreas. The most evident advantage of LDP is the shorter length of stay. Age alone should not be considered as an absolute contraindication for LDP. Obviously, it is still too early to assess oncological outcomes, but the R0 resection rate, the number of harvested lymph nodes, and the overall survival rate are superimposable to ODP. LDP is safe and feasible if compared to ODP in selected elderly patients with body and tail pancreatic tumors. Less blood loss and shorter hospital stay are the most evident advantages of minimally invasive approach. Randomized controlled trials and high-volume centers prospective studies with long-term outcomes are necessary to consider laparoscopy a standard of care. Minimally invasive robotic surgery may represent an interesting alternative to laparoscopy especially for spleen-preserving procedures.

Reproducibility of preoperative endoscopic injection of botulinum toxin into the sphincter of Oddi to prevent postoperative pancreatic fistula.

BackgroundA postoperative pancreatic fistula (POPF) is the most common and potentially life-threatening surgical complication in pancreatic surgery. One possible pharmacological treatment could be the endoscopic injection of botulinum toxin (BTX) into the sphincter of Oddi to prevent POPF. Promising data reported a significantly reduced rate of clinically relevant POPF. We analyzed the effect of BTX injection in our patients undergoing distal pancreatectomy (DP).MethodsA retrospective analysis of patients undergoing DP was performed. Patients with preoperative endoscopic injection of BTX into the sphincter of Oddi were included. The end points were postoperative outcomes including POPF. BTX patients were compared with a historical cohort and matched in a 1:1 ratio using a propensity score analysis.ResultsA total of 19 patients were treated with endoscopic injection of BTX before open (n=8) or laparoscopic (n=11) DP. The median age of the patients was 67 years and the mean body mass index was 25.9 kg/m2. In median, the intervention was performed 1 day (range, 0–14 days) before the operation. There were no intervention-related complications. The incidence of POPF was not statistically different between the two groups: a clinically relevant POPF grade (B/C) occurred in 32% (BTX) and 42% (control; p=0.737). Likewise, there were no significant differences in postoperative drain fluid amylase levels, morbidity, and mortality.ConclusionThe present study could not reproduce the published results of a significant lowering of grade B/C POPF. The explanations could be the timing of BTX injection before surgery and the endoscopic technique of BTX injection. However, the conflicting results after BTX injection in two high-volume centers prompt a randomized controlled multicenter trial with trained endoscopists.

Impact of laparoscopy in patients aged over 70years requiring distal pancreatectomy: a French multicentric comparative study.

Few data are available concerning short-term results of minimally invasive surgery in patients > 70years old requiring distal pancreatectomy. The aim of this study was to compare short-term results after laparoscopic (LDP) versus open distal pancreatectomy (ODP) in this subgroup of patients. All patients > 70years who underwent distal pancreatectomy in 3 expert centers between 1995 and 2017 were included and data were retrospectively analyzed. Demographic, intraoperative data and postoperative outcomes in LDP and ODP groups were compared. A distal pancreatectomy was performed in 109 elderly patients; LDP group included 53 patients while ODP group included 56. There were 55 (50.5%) males and 54 (49.5%) women with a median age of 75years (range 70-87). Fifty (45.9%) patients were 70-74, 40 (36.7%) patients were 75-79, and 19 (17.4%) patients were over 80years. Nine (8.2%) patients required conversion to open surgery. The median operative time was not different between LDP and ODP (204 vs. 220min, p = 0.62). The intraoperative blood loss was significantly lower in the LDP group (238 ± 312 vs. 425 ± 582ml, p = 0.009) with no difference regarding the intraoperative transfusion rate. 90-day mortality (0 vs. 5%, p = 0.42), overall complication (45.4 vs. 51.8%, p = 0.53), major complication (18.2 vs. 12.5%, p = 0.43), grade B/C pancreatic fistula (6.8 vs. 7.1%, p = 0.71), were comparable in the 2 groups. Only postoperative confusion rate was significantly lower in the LDP group (4.5 vs. 25%, p = 0.01). Median length of stay was significantly lower in the LDP group (14 ± 10 vs. 16 ± 11days, p = 0.04). R0 resection was performed in 94% of LDP patients and 89% in ODP patients without significant difference (p = 0.73). The laparoscopic approach seems to reduce blood loss, postoperative confusion, and length of stay in elderly patients requiring distal pancreatectomy.

The Hand-Assisted Laparoscopic Approach to Resection of Pancreatic Mucinous Cystic Neoplasms: An Underused Technique?

Pancreatic mucinous cystic neoplasms (MCNs) are rare tumors typically of the distal pancreas that harbor malignant potential. Although resection is recommended, data are limited on optimal operative approaches to distal pancreatectomy for MCN. MCN resections (2000-2014; eight institutions) were included. Outcomes of minimally invasive and open MCN resections were compared. A total of 289 patients underwent distal pancreatectomy for MCN: 136(47%) minimally invasive and 153(53%) open. Minimally invasive procedures were associated with smaller MCN size (3.9 vs 6.8 cm; P = 0.001), lower operative blood loss (192 vs 392 mL; P = 0.001), and shorter hospital stay(5 vs 7 days; P = 0.001) compared with open. Despite higher American Society of Anesthesiologists class, hand-assisted (n = 46) had similar advantages as laparoscopic/robotic (n = 76). When comparing hand-assisted to open, although MCN size was slightly smaller (4.1 vs 6.8 cm; P = 0.001), specimen length, operative time, and nodal yield were identical. Similar to laparoscopic/robotic, hand-assisted had lower operative blood loss (161 vs 392 mL; P = 0.001) and shorter hospital stay (5 vs 7 days; P = 0.03) compared with open, without increased complications. Hand-assisted laparoscopic technique is a useful approach for MCN resection because specimen length, lymph node yield, operative time, and complication profiles are similar to open procedures, but it still offers the advantages of a minimally invasive approach. Hand-assisted laparoscopy should be considered as an alternative to open technique or as a successive step before converting from total laparoscopic to open distal pancreatectomy for MCN.

Cost-effectiveness of laparoscopic versus open distal pancreatectomy for pancreatic cancer.

BackgroundA recent Cochrane review compared laparoscopic versus open distal pancreatectomy for people with for cancers of the body and tail of the pancreas and found that laparoscopic distal pancreatectomy may reduce the length of hospital stay. We compared the cost-effectiveness of laparoscopic distal pancreatectomy versus open distal pancreatectomy for pancreatic cancer.MethodModel based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service. A decision tree model was constructed using probabilities, outcomes and cost data from published sources. A time horizon of 5 years was used. One-way and probabilistic sensitivity analyses were undertaken.ResultsThe probabilistic sensitivity analysis showed that the incremental net monetary benefit was positive (£3,708.58 (95% confidence intervals (CI) -£9,473.62 to £16,115.69) but the 95% CI includes zero, indicating that there is significant uncertainty about the cost-effectiveness of laparoscopic distal pancreatectomy versus open distal pancreatectomy. The probability laparoscopic distal pancreatectomy was cost-effective compared to open distal pancreatectomy for pancreatic cancer was between 70% and 80% at the willingness-to-pay thresholds generally used in England (£20,000 to £30,000 per QALY gained). Results were sensitive to the survival proportions and the operating time.ConclusionsThere is considerable uncertainty about whether laparoscopic distal pancreatectomy is cost-effective compared to open distal pancreatectomy for pancreatic cancer in the NHS setting.