Laparoscopic Versus Open Pancreatoduodenectomy: Cost-Effectiveness Analysis

Background and Objectives: The role of laparoscopy during a pancreatoduodenectomy (PD) is not clearly defined. The purpose of this study was thus to compare the cost-effectiveness between laparoscopic pancreatoduodenectomy (LPD) and open pancreatoduodenectomy (OPD).Materials and Methods: From 2010 to 2019, 140 patients underwent PD (60 LPD and 80 OPD). After 60-60 matching, the clinical-pathological characteristics, surgical technique, and type of rehabilitation were identical in both groups. Complications, R0 resection, and cost were compared.Results: Complication rates were 48% (12% Clavien-Dindo grade 3-4) in the LPD group and 64% (22% Clavien-Dindo grade 3-4) in the OPD group. The LPD group had significantly fewer pulmonary complications (6%) than the OPD group (20%) (P = .04). The oncological quality of the R0 resection did not differ between the two groups. The operating time was 312 +/- 50 minutes in the OPD group and 392 +/- 75 minutes in the LPD group (P < .001). The mean length of hospital stay was significantly shorter for the LPD group (13 +/- 10) days compared to the OPD group (19 +/- 8) days (P = .02). The average cost of total hospital stay was significantly lower for the LPD group compared to the OPD group (P = .02).Conclusions: Despite longer operative times, LPD had fewer (pulmonary) complications and reduced hospital costs.