LETTER TO THE EDITOR Laparoscopic Versus Open Left Pancreatectomy: Do Risk Factors for Pancreatic Fistula Differ Between the 2 Techniques? To the Editor: e read with great interest the recent article by Cho et al1 reporting on risk factors associated with operative morbidity and pancreatic fistulae in patients undergoing open left pancreatectomy (OLP) and laparoscopic left pancreatectomy (LLP). The authors concluded that such risk factors differ when open versus laparoscopic techniques are employed and that some of these may identify cohorts of patients who will benefit more from LLP. Therefore, LLP may be the operative procedure of choice for most patients with left-sided pancreatic lesions. We actually feel in line with the authors regarding the need for a more definitive prospective randomized study to draw definitive conclusions on this topic. However, we encountered some difficulties in interpreting several presented data throughout the manuscript and wonder if the
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authors can help us to better understand some supposed discrepancies that might affect their conclusions. At the time of our first submission to the journal (June 2011), we noted that the percentages of patients in Table 3 did not match with those depicted for the OLP group in Table 1. Moreover, the authors had reported splenic preservation (“splenectomy”) and the use of nonstapled parenchymal transection were associated with a higher likelihood of major complications after OLP in the Results section but not in Table 3. In this case, their conclusion that risk factors for major complications differed when open versus laparoscopic techniques were employed might have been unlikely because no variables were associated with a higher likelihood of major complications even after LLP (Table 4). Indeed, we have subsequently appreciated that the authors regretted the error as promptly reported, clarifying the impact of the 2 techniques on major complications.2 The authors had also reported BMI greater than 27 and pancreatic specimen length greater than 8.5 cm were risk factors for clinically significant pancreatic fistulae after LLP. However, these results seem not to match with those reported in Table 6 where splenectomy rather than pancreatic length was reported on multivariate analysis as an independent variable associated with
significant fistulae after LLP. Depending on the findings, the authors’ conclusion that risk factors for pancreatic fistulae differ when open versus laparoscopic techniques are employed might be unlikely because splenectomy was a reported independent risk factors for a significant fistulae even after OLP. We are therefore not able to understand which results are the correct ones (text or Table 6?). We thank the authors to help us in better understanding the conclusions of their manuscript. Paolo Limongelli, MD, PhD Andrea Belli, MD Giulio Belli, MD Department of General and Hepato-Pancreato-Biliary Surgery S. M. Loreto Nuovo Hospital Via A. Vespucci 80142 Naples, Italy [email protected]
REFERENCES 1. Cho CS, Kooby DA, Schmidt CM, et al. Laparoscopic versus open left pancreatectomy: can preoperative factors indicate the safer technique? Ann Surg. 2011;253:975–980. 2. Cho CS, Kooby DA, Schmidt CM, et al. Erratum: Laparoscopic versus open left pancreatectomy: can preoperative factors indicate the safer technique? Ann Surg. 2011;254:391.
Disclosure: All authors have no conflict of interest and no source of funding. C 2013 by Lippincott Williams & Wilkins Copyright ISSN: 0003-4932/13/25903-e0039 DOI: 10.1097/SLA.0000000000000356
Annals of Surgery r Volume 259, Number 3, March 2014
www.annalsofsurgery.com | e39
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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authors can help us to better understand some supposed discrepancies that might affect their conclusions. At the time of our first submission to the journal (June 2011), we noted that the percentages of patients in Table 3 did not match with those depicted for the OLP group in Table 1. Moreover, the authors had reported splenic preservation (“splenectomy”) and the use of nonstapled parenchymal transection were associated with a higher likelihood of major complications after OLP in the Results section but not in Table 3. In this case, their conclusion that risk factors for major complications differed when open versus laparoscopic techniques were employed might have been unlikely because no variables were associated with a higher likelihood of major complications even after LLP (Table 4). Indeed, we have subsequently appreciated that the authors regretted the error as promptly reported, clarifying the impact of the 2 techniques on major complications.2 The authors had also reported BMI greater than 27 and pancreatic specimen length greater than 8.5 cm were risk factors for clinically significant pancreatic fistulae after LLP. However, these results seem not to match with those reported in Table 6 where splenectomy rather than pancreatic length was reported on multivariate analysis as an independent variable associated with
significant fistulae after LLP. Depending on the findings, the authors’ conclusion that risk factors for pancreatic fistulae differ when open versus laparoscopic techniques are employed might be unlikely because splenectomy was a reported independent risk factors for a significant fistulae even after OLP. We are therefore not able to understand which results are the correct ones (text or Table 6?). We thank the authors to help us in better understanding the conclusions of their manuscript. Paolo Limongelli, MD, PhD Andrea Belli, MD Giulio Belli, MD Department of General and Hepato-Pancreato-Biliary Surgery S. M. Loreto Nuovo Hospital Via A. Vespucci 80142 Naples, Italy [email protected]
REFERENCES 1. Cho CS, Kooby DA, Schmidt CM, et al. Laparoscopic versus open left pancreatectomy: can preoperative factors indicate the safer technique? Ann Surg. 2011;253:975–980. 2. Cho CS, Kooby DA, Schmidt CM, et al. Erratum: Laparoscopic versus open left pancreatectomy: can preoperative factors indicate the safer technique? Ann Surg. 2011;254:391.
Disclosure: All authors have no conflict of interest and no source of funding. C 2013 by Lippincott Williams & Wilkins Copyright ISSN: 0003-4932/13/25903-e0039 DOI: 10.1097/SLA.0000000000000356
Annals of Surgery r Volume 259, Number 3, March 2014
www.annalsofsurgery.com | e39
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
