,Ciinical value and cost-effectiveness of minimally invasive distal pancreatectomy

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Minimally invasive pancreatic resection (MIPR) has gained popularity in the last decade and it is currently widely applied with selected indications in highly specialized centres worldwide. Distal pancreatectomy (DP), which lacks of a technical demanding and complex reconstruction phase, is the most suitable pancreatic resection for a minimal invasive approach and is therefore the most performed MIPR. Several non-randomized studies and meta-analyses suggested that a minimally invasive distal pancreatectomy (MIDP) could improve the short-term postoperative outcomes by reducing the intraoperative blood loss and the postoperative morbidity when compared to open distal pancreatectomy (ODP) (1). MIDP seems also to promote an earlier recovery and a reduction in the length of postoperative stays when compared to ODP without affecting the oncologic outcomes. Therefore, the diffusion of MIDP is increasing and a minimally invasive approach is generally recognized as a suitable approach to benign, borderline malignant lesions and to Pan-NENs. The value of MIDP for the surgical treatment of pancreatic ductal adenocarcinoma (PDAC) is still under evaluation despite its feasibility and safety in this setting have been demonstrated and similar long-term oncological outcomes were reported by several single and multicentre series (2). The recent published DIPLOMA study, a European retrospective propensity score-matched cohort study on minimally invasive versus open DP for PDAC, raised some conces in terms of oncological adequacy of MIDP (3). In fact, despite a similar reported overall survival between ODP and MIDP a lower lymph
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