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Vol. 99. Issue 3.
Pages 250-251 (March 2021)
Vol. 99. Issue 3.
Pages 250-251 (March 2021)
Letter to the Editor
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Response to the Letter to the Editor on the article “Highs and lows in laparoscopic pancreaticoduodenectomy”
Respuesta a la Carta al Director relativa al artículo «Luces y sombras de la duodenopancreatectomía cefálica laparoscópica»
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Francisco Espin Alvareza, María Isabel García Domingob, Manel Cremades Péreza,
Corresponding author
mcremades@outlook.com

Corresponding author.
, Esteban Cugat Andorráa,b
a Unidad de Cirugía Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
b Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain
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Cir Esp. 2021;99:249-5010.1016/j.cireng.2020.11.014
Miguel Ángel Suárez Muñoz, Jorge Francisco Roldán de la Rúa, Luis Carlos Hinojosa Arco, Yolanda Eslava Cea
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To the Editor

First of all, we thank you for the opportunity to reply to the Letter to the Editor by Suarez Muñoz et al1 under the title “Laparoscopic cephalic pancreatoduodenectomy: May we illuminate some shadows?”, in reference to the article on laparoscopic pancreaticoduodenectomy.2

Second, we the authors would like to thank them for their interest and comments in the aforementioned Letter to the Editor. Undoubtedly, this concern regarding safety in pancreaticoduodenectomy is shared between both groups, which is reflected in the experiences published.3 It is not necessary to re-emphasize the high complexity of pancreatic surgery, especially pancreaticoduodenectomy, which requires special involvement from the onset of symptoms and diagnosis through preoperative management, as well as early detection and anticipation in the appearance of complications. All of this requires special thoroughness from all those involved, especially the surgical teams.

We fully agree that experience in hepatobiliary-pancreatic surgery, as well as previous planning of cases, planned conversions or hybrid surgery, are key in the learning curve of laparoscopic pancreaticoduodenectomy, always with patient safety as the main objective. At the same time, we must also guarantee the standards of oncological surgery and a rapid recovery that does not hinder completing adjuvant treatment.

What is currently being debated is the actual number of cases required to overcome the learning curve using an approach by stages,4,5 or even the need to institute adequate accreditation and quality control measures, prior to routine clinical application.6 As the authors of this Letter to the Editor mentioned, initial series suggest that a hybrid approach could facilitate progression to final competence in laparoscopic pancreaticoduodenectomy.7

References
[1]
M.A. Suárez Muñoz, J.F. Roldán de la Rúa, L.C. Hinojosa Arco, Y. Eslava Cea.
Duodenopancreatectomía cefálica laparoscópica: ¿podemos iluminar algunas sombras?.
[2]
F. Espín Álvarez, M.I. García Domingo, M. Cremades Pérez, E. Herrero Fonollosa, J. Navinés López, J. Camps Lasa, et al.
Luces y sombras de la duodenopancreatectomía cefálica laparoscópica.
[3]
M.A. Suárez Muñoz.
Complicaciones y secuelas de la cirugía pancreática. ¿Cómo intentamos prevenirlas?.
Cir And, 30 (2019), pp. 181-185
[4]
P.J. Speicher, D.P. Nussbaum, R.R. White, S. Zani, P.J. Mosca, D.G. Blazer 3rd, et al.
Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy.
Ann Surg Oncol., 21 (2014), pp. 4014-4019
[5]
R. Qin, M.L. Kendrick, C.L. Wolfgang, B.H. Edil, C. Palanivelu, R.W. Parks, et al.
International expert consensus on laparoscopic pancreaticoduodenectomy.
Hepatobiliary Surg Nutr., 9 (2020), pp. 464-483
[6]
J. van Hilst, T. de Rooij, M. Abu Hilal, H.J. Asbun, J. Barkun, U. Boggi, et al.
Worldwide survey on opinions and use of minimally invasive pancreatic resection.
[7]
U.F. Wellner, S. Kusters, O. Sick, C. Busch, P. Bronsert, et al.
Hybrid laparoscopic versus open pylorus-preserving pancreatoduodenectomy: retrospective matched case comparison in 80 patients.
Langenbecks Arch Surg., 399 (2014), pp. 849-856

Please cite this article as: Espin Alvarez F, García Domingo MI, Cremades Pérez M, Cugat Andorrá E. Respuesta a la Carta al Director relativa al artículo «Luces y sombras de la duodenopancreatectomía cefálica laparoscópica». Cir Esp. 2021;99:250–251.

Copyright © 2020. AEC
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