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Updated: Feb 19, 2026
Laparoscopic Radical Left Pancreatectomy for Pancreatic Cancer: Surgical Strategy and Technique Video
Published on: June 6, 2020
The Value of Decision Analytical Modeling in Surgical Research: An Example of Laparoscopic Versus Open Distal
Casper Tax1, Paulien H M Govaert2, Martijn W J Stommel3
1Department of Operating Rooms, Radboud University Medical Centre, Radboudumc Institute for Health Sciences, Nijmegen, The Netherlands.
Objective:
To illustrate how decision modeling may identify relevant uncertainty and can preclude or identify areas of future research in surgery.
Summary Background Data:
To optimize use of research resources, a tool is needed that assists in identifying relevant uncertainties and the added value of reducing these uncertainties.
Methods:
The clinical pathway for laparoscopic distal pancreatectomy (LDP) versus open (ODP) for nonmalignant lesions was modeled in a decision tree. Cost-effectiveness based on complications, hospital stay, costs, quality of life, and survival was analyzed. The effect of existing uncertainty on the cost-effectiveness was addressed, as well as the expected value of eliminating uncertainties.
Results:
Based on 29 nonrandomized studies (3.701 patients) the model shows that LDP is more cost-effective compared with ODP. Scenarios in which LDP does not outperform ODP for cost-effectiveness seem unrealistic, e.g., a 30-day mortality rate of 1.79 times higher after LDP as compared with ODP, conversion in 62.2%, surgically repair of incisional hernias in 21% after LDP, or an average 2.3 days longer hospital stay after LDP than after ODP. Taking all uncertainty into account, LDP remained more cost-effective. Minimizing these uncertainties did not change the outcome.
Conclusions:
The results show how decision analytical modeling can help to identify relevant uncertainty and guide decisions for future research in surgery. Based on the current available evidence, a randomized clinical trial on complications, hospital stay, costs, quality of life, and survival is highly unlikely to change the conclusion that LDP is more cost-effective than ODP.
