LAUSR

Editor We thank Drs Hu and Wu for their comments on the LAPOP trial1. We agree that nutritional status is important. Owing to randomization, no group difference in preoperative nutritional status was expected. On post-hoc comparison, no difference was found in haemoglobin or albumin; prealbumin is not measured routinely. Sex distribution was not completely equal between groups, but analysing separately by sex found no differences. Thus, difference in outcome is unlikely to depend on nutritional status. Variations in perioperative care could introduce bias. However, all patients underwent the same fast-track programme1,2. Also, as hospital stay was measured in several ways, including readmission stays and stay at the referring hospital, it is unlikely that the results are biased by variations in perioperative care. Variation in blood loss based on surgeons’ experience could in theory account for the differences found. However, we believe this to be unlikely. As stated, laparoscopic distal pancreatectomies were performed by a single surgeon, whereas open resections were performed by one of three senior pancreatic surgeons. Similar findings were reported by the LEOPARD investigators3.