Indications Are Missing
Despite its title, this article does not answer the question of what are the indications for laparoscopic pancreatic surgery (1).
A meaningful statistical evaluation about the indication for laparoscopic (rather than conventional open) pancreatic surgery is neither described in the publication nor can be deduced based on the available data. What then is the purpose of the comparison with other registries?
The “advantages of clinical registry studies” include “heterogeneous patient group” and “heterogeneous conditions and centers.” These factors exclude obtaining comparable results a priori.
Table 5 lists only two multicenter studies but six unicenter studies for comparable publications, yet the latter cannot be regarded as registries. Thus, neither of the above-mentioned criteria—heterogeneous conditions and centers, and the comparability with multicenter studies—is present.
In the discussion, the authors state: “clinical registry studies… [are] better at reflecting the overall current care situation in the geographical region of interest.” What is the question being addressed here? Is it whether there are indications for laparoscopic pancreatic surgery? Or is it the care situation in the geographical regions of interest?
In any case, registry studies are highly unlikely to replace prospective randomized controlled studies as the gold standard in the foreseeable future.
Ultimately, the data only support the statement that laparoscopic pancreatic surgery is performed with certain results in certain (highly selected) patients in Germany; however, the given data do not address the question of whether the method is indeed justified. The explanatory value of the data is low in any case due to patient selection by the participating centers.
Dr. med. Benedikt Lampl
|1.||Siech M, Strauß P, Huschitt S, et al.: The indications for laparoscopic pancreatectomy—results on 550 patients in the German Laparoscopic Pancreas Registry in comparison to other registries. Dtsch Arztebl Int 2017; 114: 263–8 VOLLTEXT|