Conlon Kevin C, de Rooij Thijs, van Hilst Jony, Abu Hidal Mohammad, Fleshman Julie, Talamonti Mark, Vanounou Tsafrir, Garfinkle Richard, Velanovich Vic, Kooby David, Vollmer Charles M
Professorial Surgical Unit, Trinity College Dublin, The University of Dublin, Ireland.
Department of Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands.
HPB (Oxford). 2017 Mar;19(3):225-233. doi: 10.1016/j.hpb.2017.01.019. Epub 2017 Mar 6.
The number of minimally invasive pancreatic resections (MIPR) performed for benign or malignant disease, have increased in recent years. However, there is limited information regarding cost/value implications.
An international conference evaluating MIPR was held during the 12th Bi-Annual International Hepato-Pancreato-Biliary Association (IHPBA) World Congress in Sao Paulo, Brazil, on April 20th, 2016. This manuscript summarizes the presentations that reviewed current topics in cost and value as they pertain to MIPR.
Compared to the open approach, MIPR's are associated with higher operative costs but lower postoperative costs. However, measurements of patient value (defined as improvement in both quantity and quality of life) and financial value (using incremental cost-effectiveness ratio) are required to determine the true value at societal level.
Challenges remain as to how the potential benefits, both to the patient and the healthcare system as a whole, are measured. Research comparing MIPR versus other techniques for pancreatectomy will require appropriate and valid measurement tools, some of which are yet to be refined. Nonetheless, the experience to date would support the continued development of MIPR by experienced surgeons in high-volume pancreatic centers, married with appropriate review and recalibration.
近年来，因良性或恶性疾病而进行的微创胰腺切除术（MIPR）数量有所增加。然而，关于成本/价值影响的信息有限。
2016年4月20日，在巴西圣保罗举行的第12届国际肝胰胆协会（IHPBA）双年世界大会期间，召开了一次评估MIPR的国际会议。本手稿总结了回顾与MIPR相关的成本和价值当前主题的报告。
与开放手术相比，MIPR的手术成本较高，但术后成本较低。然而，需要衡量患者价值（定义为生活质量和数量的改善）和财务价值（使用增量成本效益比），以确定社会层面的真正价值。
在如何衡量对患者和整个医疗系统的潜在益处方面，挑战依然存在。比较MIPR与其他胰腺切除术技术的研究将需要适当且有效的测量工具，其中一些工具尚未完善。尽管如此，迄今为止的经验将支持经验丰富的外科医生在大容量胰腺中心继续开展MIPR，并进行适当的审查和重新校准。
