Comprehensive comparative analysis of cost-effectiveness and perioperative outcomes between open, laparoscopic, and robotic distal pancreatectomy

Abstract

Background: NSQIP data show that half of distal pancreatectomies (DP) are performed by a minimally invasive approach (MIS). Advantages have been demonstrated for MIS DP, yet comparative cost data are limited. Outcomes and cost were compared in patients undergoing open (ODP), laparoscopic (LDP), and robotic (RDP) approaches at a single institution. Methods: A retrospective review was performed on patients undergoing DP between 1/2010-5/2016. Analysis was intention-to-treat, and cost was available after 1/2013. Results: DP was performed in 374 patients: ODP = 85, LDP = 93, and RDP = 196. Operating time was lowest in the RDP cohort (p < 0.0001). ODP had higher estimated blood loss (p < 0.0001) and transfusions (p < 0.0001) than LDP and RDP. LDP had greater conversions to open procedures than RDP (p = 0.001). Postoperative outcomes were similar between groups. Length of stay was higher in the ODP group (p = 0.0001) than LDP and RDP. Overall cost for the ODP was higher than the RDP and LDP group

A cost‐effectiveness analysis of robotic versus laparoscopic distal pancreatectomy

“…Reviewing the current literature of RDP vs LDP, only eight studies address the costs in their analysis. [7][8][9][10][11][12][13][14][15][16] The first report was by Waters et al, 13 where overall cost of RDP was lower compared with LDP ($10 588 vs $12 986), in spite of higher operative costs for RDP ($3072 vs $4898) due, similarly to our study, to a shorter hospital stay.…”

“…For the majority of robotic cost studies published in the literature, the financial analyses were performed by the same centers that conducted the studies, which may have led to a potential bias. [7][8][9][10][11][12][13][14][15][16] In recent years, there has been an increased number of available robotic systems in hospitals, in particular due to a cost reduction of this technology: This is expected to become even more important in the near future on expiry of some existing licenses, therefore, improving its cost-effectiveness even more.…”

“…Among minimally invasive pancreatic resections, distal pancreatectomy is the most performed procedure and the costs of laparoscopic distal pancreatectomy (LDP) versus robotic distal pancreatectomy (RDP) have only been assessed in 10 series, none of which corresponds to a cost‐effectiveness study …”

“…Among minimally invasive pancreatic resections, distal pancreatectomy is the most performed procedure and the costs of laparoscopic distal pancreatectomy (LDP) versus robotic distal pancreatectomy (RDP) have only been assessed in 10 series, none of which corresponds to a cost-effectiveness study. [7][8][9][10][11][12][13][14][15][16] Therefore, given this background, with this prospective study, we sought to assess the cost-effectiveness of RDP and LDP for the first time.…”

Robotic-assisted versus open distal pancreatectomy for benign and low-grade malignant pancreatic tumors: a propensity score-matched study

“…Minimally invasive distal pancreatectomy was first applied in 1992 [1] and has become increasingly popular in recent years [2,3]. Robotic-assisted distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP), as two kinds of minimally invasive surgery for left-side pancreatic tumors, both showed noninferior short-term outcomes and even oncological outcomes in previous studies [4][5][6], the newest guideline about minimally invasive pancreas resection, also paid noticeable attention on minimally invasive distal pancreatectomy [7].…”