Evaluation of cost-effectiveness among open, laparoscopic and robotic distal pancreatectomy: A systematic review and meta-analysis

Background: The cost-effectiveness of minimally invasive distal pancreatectomy (MIDP) is still a matter of debate. This study compares the cost-effectiveness of open (ODP), laparoscopic (LDP) and robotic distal pancreatectomy (RDP). Methods: Pubmed, Web of Science and Cochrane Library databases were searched. Studies comparing cost-effectiveness of ODP and MIDP were included. Results: A total of 1052 titles were screened and 16 articles were included in the study, 2431 patients in total. LDP resulted the most cost-efficient procedure, with a mean total cost of 14,682 +/- 5665 V and the lowest readmission rates. ODP had lower surgical procedure costs, 3867 +/- 768 V. RDP was the safest approach regarding hospital stay costs (5239 +/- 1741 V), length of hospital stay, morbidity, clinically relevant pancreatic fistula and reoperations. Conclusion: In this meta-analysis MIDP resulted as the most cost-effective approach. LDP seems to be protective against high costs, but RDP seems to be safer. (C) 2021 Elsevier Inc. All rights reserved.