Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curvevslaparotomy

Abstract

TLPD is safe when performed by experienced pancreatobiliary surgeons during the initial learning curve, but has a higher cost than open pancreaticoduodenectomy.

Randomized clinical trial of laparoscopicversusopen pancreatoduodenectomy for periampullary tumours

“…Since the beginning of this decade, several reports from other centres have documented comparative data for these two procedures. However, until now, no randomized trial existed.…”

Analysis of the Cost Effectiveness of Laparoscopic Pancreatoduodenectomy

“…Studies aimed at assessing the potential value of LPD with respect to obtaining negative retroperitoneal margin may be warranted. Further, this study does not account for the impact of a learning curve when implementing LPD that associates with increased OR time, but not necessarily increased complications [6, 13, 19, 22]. Specific to increased OR time that would impact cost, this learning curve is realized somewhere between ten and fifty cases [6].…”

“…Collectively, these studies have identified potential benefits to LPD including decreased blood loss, delayed gastric emptying rates, hospital length of stay, wound infection rates, and utilization of intensive care services, while facilitating larger percentages of patients proceeding on to adjuvant therapy [6–11]. These benefits even appear to be realized during the institutions early experience with LPD [6, 13, 14]. Further, there does not appear to be a clinically meaningful difference between the approaches with respect to surrogate markers of oncologic adequacy including positive margin rates [6, 8–10] and number of resected lymph nodes [6, 8–10, 13].…”

“…These benefits even appear to be realized during the institutions early experience with LPD [6, 13, 14]. Further, there does not appear to be a clinically meaningful difference between the approaches with respect to surrogate markers of oncologic adequacy including positive margin rates [6, 8–10] and number of resected lymph nodes [6, 8–10, 13]. Recently, we and others have reported similar long term oncologic outcomes between the approaches including disease free and overall survival [10, 15].…”

“…Only a limited number of small studies have published comparative cost data between LPD and OPD [6, 7, 13, 16]. These studies evaluated hospital costs associated with the surgical procedure and index hospitalization, showing increased operative costs are recouped by reduction in other costs (i.e.…”