Laparoscopic Versus Open Pancreatoduodenectomy: Cost-Effectiveness Analysis

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• The role of laparoscopy in pancreatoduodenectomy (PD) remains unclear.
• Comparing laparoscopic pancreatoduodenectomy (LPD) and open pancreatoduodenectomy (OPD) is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To evaluate the cost-effectiveness of LPD versus OPD.
• To compare complication rates, oncological outcomes, and economic impact between LPD and OPD.

Main Methods:

• A retrospective analysis of 140 patients who underwent PD between 2010 and 2019 (60 LPD, 80 OPD).
• Utilized 60-60 matching to ensure comparable clinical-pathological characteristics, surgical techniques, and rehabilitation types between groups.
• Compared complication rates (including Clavien-Dindo grade 3-4), R0 resection rates, operative times, length of hospital stay, and total hospital costs.

Main Results:

• LPD group showed significantly lower overall complication rates (48% vs. 64%) and fewer pulmonary complications (6% vs. 20%) compared to OPD (P=.04).
• No significant difference in R0 resection rates, indicating similar oncological efficacy.
• LPD involved longer operative times (392±75 min vs. 312±50 min, P<.001) but resulted in shorter hospital stays (13±10 days vs. 19±8 days, P=.02) and lower total costs (P=.02).

Conclusions:

• Laparoscopic pancreatoduodenectomy is a cost-effective procedure with a favorable safety profile.
• LPD leads to reduced postoperative complications, particularly pulmonary issues, and decreased healthcare expenditure compared to open pancreatoduodenectomy.
• Despite longer operative durations, the benefits of LPD in terms of patient recovery and cost savings support its consideration in pancreatic surgery.