We read with great interest the article entitled “Highs and lows in laparoscopic pancreaticoduodenectomy”, by Espin F et al., 1 in the journal Cirugía Española. In this article, they evaluated the efficacy and safety of laparoscopic pancreaticoduodenectomy (LPD) compared to open pancreaticoduodenectomy (OPD) performed in a total of 54 patients, 23 and 31 respectively, after which they were able to determine that the best option is LPD in appropriately selected patients.
Pancreaticoduodenectomy (PC) is an effective treatment for pancreatic cancer, but major complications can occur, resulting in increased postoperative morbidity and mortality, such as healthcare-associated infections and pancreatic fistulas.2 Minimally invasive surgery (MIS) has been developed with the intention of achieving satisfactory oncologic results with considerable advantages. Even so, the laparoscopic technique is not currently the technique of choice to perform PC, due to the possible complications, mainly linked to a decrease in the skill of the surgical technique.1
An indicator that supports the use of the laparoscopic technique is the post-surgical hospital stay. The difference between the post-surgical hospital stay for LPD (8.5 days) and OPD (15 days)1 represents a fundamental factor in the patient's recovery, since a prolonged hospital stay restricts the capacity of the health care institutions, which generates a decrease in the availability of beds; amplifies the risk of contracting an infection associated with health care; and increases the cost of healthcare services due to the excessive and unnecessary use of supplies and labor.3 Consequently, LPD presents a better efficiency indicator in terms of post-surgical hospital stay.
With regard to postoperative pancreatic fistulas, out of 23 LPD performed, 8.7% of the patients presented this complication, and 31 patients who underwent OPD did not present cases,1 in comparison with another larger study that took 193 patients as a basis, where it was found that 12.3% presented pancreatic fistulas in OPD, as well as 11.8% of 58 patients who underwent LPD. We can evidence a lower prevalence of fistulas in the first study, which may be due to the fact that this is a non-randomized analysis with a smaller observed sample.4 In view of the above, we consider that the laparoscopic technique performed by qualified personnel is the best option to reduce the probability of pancreatic fistulas.
As indicated, although the analysis concludes that LPD is safe in selected patients, randomized research should be carried out with a larger sample to guarantee conclusively that LPD is the best option, since other studies have observed a much higher risk margin.5 In addition, we agree with the authors that adequate training of the professionals who perform LPD should be encouraged in order to reduce these risks and define it as the most appropriate.
Ethical approvalNot required.
FundingNone.
Conflicts of interestNone declared.
