To the Editor.–I have noted with great interest the communication by Bloom and Steer entitled "Pancreatoduodenectomy: Results When the Operation Is Performed Infrequently" in the December 1975 issue of the Archives (110:1455-1457, 1975). The conclusion is reached by the authors that pancreatoduodenectomy "could be safely done by any surgeon who is technically competent to perform complicated operations, who is familiar with the relevant literature, and who approaches the operation with meticulous attention to detail." This opinion is based on an experience with 13 pancreatoduodenectomies of which three were done for benign disease and ten for periampullary malignancy over the course of nine years.
I have several serious objections to this article, the main one being that such sweeping conclusions are drawn from a limited experience. These conclusions have very serious consequences. There is no doubt in my mind that at least 30,000 surgeons in this country might consider themselves