Reviewer ’s report  
 
Title: Preoperative anthropomorphic and nutritious status and fistula ris k score for predicting 
clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy  
 
Version: 1 Date: 07 Jan 2020  
 
Reviewer's report:  
 
In this study, the authors analyzed the predictability of POPF after PD by using the combination 
of body composition data and fistula risk score.  
 
Major  
1. The POPF rate of 30.9% is relatively high. This high rate of POPF in this study may make the 
study results not reasonably applicable to other studies. The authors should comment on this.  
2. Why did the variable of PNI &lt;45 that was significant in uni variate analysis not included in 
multivariate analysis?  
3. If the authors claim that the combination of body composition data and FRS accurately 
predicts POPF, the validation model is needed.  
4. High visceral adipose tissue, low skeletal muscle mass, and h igh RFS score are already 
recognized as risk factors for POPF after PD in many studies. The combination of them seems to 
be obvious to be the risk factor. Therefore, this study does not seem to provide any novel 
findings.  
 
 
Minor  
1. The context in the Back ground section is not going well along with the content of this study. 
First, although there is the statement regarding lap vs. open, the use of minimally invasive 
technique is not a thing mainly evaluated in this study. Second, although there is the state ment 
that POPF can result in fatal complication or worse prognosis, association between the 
occurrence of POPF and patients' prognosis is not a thing focused in this study. Third, although 
there is the statement regarding the prevention of POPF, preventive  measures are not evaluated 
in this study. The statements not relevant with the study should be deleted. Instead, the reasons 
of why the authors used the combination of body composition data and fistula risk score should 
be explained.  
2. In the Background section the sentence of age, hormone levels, cancer, and inflammation… 
(page 5, line 20) should have some reference of previous reports.  
3. The "trained investigators" of CT analysis who are ideally be radiologists should be indicated 
with their initials ( page 6, line 2).  
4. How could the "infected" fluid collection be detected on CT (page 8, line 30)?  
5. VATA/SMI is expected to facilitate early drain removal (page 16, line 20): this should not be 
mentioned as conclusion because this is not supported by any  results of this study.  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of compet ing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now o r in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relating  to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscrip t is accepted f or publication, my name d report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creati vecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Preoperative anthropomorphic and nutritious status and fistula ris k score for predicting 
clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy  
 
Version: 1 Date: 07 Jan 2020  
 
Reviewer's report:  
 
In this study, the authors analyzed the predictability of POPF after PD by using the combination 
of body composition data and fistula risk score.  
 
Major  
1. The POPF rate of 30.9% is relatively high. This high rate of POPF in this study may make the 
study results not reasonably applicable to other studies. The authors should comment on this.  
2. Why did the variable of PNI &lt;45 that was significant in uni variate analysis not included in 
multivariate analysis?  
3. If the authors claim that the combination of body composition data and FRS accurately 
predicts POPF, the validation model is needed.  
4. High visceral adipose tissue, low skeletal muscle mass, and h igh RFS score are already 
recognized as risk factors for POPF after PD in many studies. The combination of them seems to 
be obvious to be the risk factor. Therefore, this study does not seem to provide any novel 
findings.  
 
 
Minor  
1. The context in the Back ground section is not going well along with the content of this study. 
First, although there is the statement regarding lap vs. open, the use of minimally invasive 
technique is not a thing mainly evaluated in this study. Second, although there is the state ment 
that POPF can result in fatal complication or worse prognosis, association between the 
occurrence of POPF and patients' prognosis is not a thing focused in this study. Third, although 
there is the statement regarding the prevention of POPF, preventive  measures are not evaluated 
in this study. The statements not relevant with the study should be deleted. Instead, the reasons 
of why the authors used the combination of body composition data and fistula risk score should 
be explained.  
2. In the Background section the sentence of age, hormone levels, cancer, and inflammation… 
(page 5, line 20) should have some reference of previous reports.  
3. The "trained investigators" of CT analysis who are ideally be radiologists should be indicated 
with their initials ( page 6, line 2).  
4. How could the "infected" fluid collection be detected on CT (page 8, line 30)?  
5. VATA/SMI is expected to facilitate early drain removal (page 16, line 20): this should not be 
mentioned as conclusion because this is not supported by any  results of this study.  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of compet ing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now o r in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relating  to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscrip t is accepted f or publication, my name d report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creati vecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Preoperative anthropomorphic and nutritious status and fistula ris k score for predicting 
clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy  
 
Version: 1 Date: 07 Jan 2020  
 
Reviewer's report:  
 
In this study, the authors analyzed the predictability of POPF after PD by using the combination 
of body composition data and fistula risk score.  
 
Major  
1. The POPF rate of 30.9% is relatively high. This high rate of POPF in this study may make the 
study results not reasonably applicable to other studies. The authors should comment on this.  
2. Why did the variable of PNI &lt;45 that was significant in uni variate analysis not included in 
multivariate analysis?  
3. If the authors claim that the combination of body composition data and FRS accurately 
predicts POPF, the validation model is needed.  
4. High visceral adipose tissue, low skeletal muscle mass, and h igh RFS score are already 
recognized as risk factors for POPF after PD in many studies. The combination of them seems to 
be obvious to be the risk factor. Therefore, this study does not seem to provide any novel 
findings.  
 
 
Minor  
1. The context in the Back ground section is not going well along with the content of this study. 
First, although there is the statement regarding lap vs. open, the use of minimally invasive 
technique is not a thing mainly evaluated in this study. Second, although there is the state ment 
that POPF can result in fatal complication or worse prognosis, association between the 
occurrence of POPF and patients' prognosis is not a thing focused in this study. Third, although 
there is the statement regarding the prevention of POPF, preventive  measures are not evaluated 
in this study. The statements not relevant with the study should be deleted. Instead, the reasons 
of why the authors used the combination of body composition data and fistula risk score should 
be explained.  
2. In the Background section the sentence of age, hormone levels, cancer, and inflammation… 
(page 5, line 20) should have some reference of previous reports.  
3. The "trained investigators" of CT analysis who are ideally be radiologists should be indicated 
with their initials ( page 6, line 2).  
4. How could the "infected" fluid collection be detected on CT (page 8, line 30)?  
5. VATA/SMI is expected to facilitate early drain removal (page 16, line 20): this should not be 
mentioned as conclusion because this is not supported by any  results of this study.  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of compet ing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now o r in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relating  to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscrip t is accepted f or publication, my name d report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creati vecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant