Reviewer ’s report  
 
Title: Preoperative anthropomorphic and nutritious status and fi stula risk score for predicting 
clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy  
 
Version: 2 Date: 14 Jun 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.  
 
1. It is not easy to understand which factors the authors decide d to include in the modified 
prediction scoring system. They are only suggested in the subtitle of the Method section. Authors 
should explain why only high FRS and VATA/SMI were included in this system and PNI was 
excluded, if it is right, even though PNI &lt; 45 was also shown as an independent predictor of 
POPF. However, if PNI is included in the scoring system, that may deviate from the study aim.  
 
2. The first sentence of the Discussion does not indicate that PNI was an independent risk factor. 
If PNI i s recognized as another risk factor, this manuscript should be revised all over. In the 
conclusion sections, should clinicians not monitor those patients with PNI &lt; 45? 
 
3. In this revision, authors have included VATA, VATA/SATA, and VATA/SMI. Confounding 
between these variables is anticipated. Authors should give reasonable explanation of including 
these variables in multivariable analysis this time. Authors should also c larify how they 
determined those cut -offs. 
 
4. I don't think the flow of the current form of the second paragraph of the Introduction section is 
fine. I suggest deleting those sentences as follows.  
Among the postoperative complications, severe POPF remains  to be of utmost concern since it 
can result in massive bleeding. →This sentence should be the second of the first paragraph.  
Improvements in surgical techniques and perioperative management strategies have remarkably 
reduced the morbidity and mortality ra tes after PD, which are reportedly 15 -44% and 1 -4%, 
respectively. →Because this sentence overlaps with the first sentence of the first paragraph, 
deletion or revision is advised.  
In 2016, the International Study Group on Pancreatic 69 Fistula (ISGPF) redef ined POPF and 
recognized its prevalence at 13 -30%. →This sentence should be the third of the first paragraph. 
Then, reported risk factors of POPF should be mentioned.  
 
5. The estimated reasons of high rate of POPF should be described in the Discussion sect ion. 
 
6. Did the investigators of CT analysis not satisfy the authorship criteria?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 recommend additional statistical review  
 
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 competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, fee s, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financiall y 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 organizati on 
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 a bove, write 'I declare that I have  no competing  interests' 
below. If your reply is yes to any, please give details below.  
 
None declared.  
 
Reviewer Publication Consent. I agree for my report to be made  available under an Open 
Access Creative Commons CC -BY Li cense ( http://creativecommons.org/licenses/by/4.0 ) if this 
manuscript  is accepted for publication. Any comments that I do not wish to be included in the 
published  report have been included as confidential comments to the editor, which will not be 
published.  If you are not happy for us to publish this report, please contact the editorial office 
before completing  the review.  If you wish, you can include your name in you r published report. 
Please note you must  decide whether to include your name at the start of the process and confirm 
this decision whenever  prompted. If you change your decision later, we will not be able to 
publish your name.  
 
I agree to the terms of the C C-BY 4.0 license; please do not publish my name with my report. 
(default)  
 
Publons Reviewer Recognition . Springer Nature can send verifica tion of this review directly to 
Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of t his service, 
please click on the “Yes” option below. Your name, email  address, title of the reviewed 
manuscript, name of the journal, and date of your review submission (the “Review Data ”) will 
then be transmitted to Publons upon publication of the manuscr ipt. If you have already registered 
at Publons, they will notify you of the receipt of this review and update your profile as per your 
settings and their policy. If you are not registered with Publons,  you will re ceive an email from 
them asking you to regi ster in order for them to be able to re cognize your review on your new 
profile page. Publons may use the Review Data to generate derivat ive metadata for the benefit of 
Publons and you as a reviewer, carefully considering the sensitivity of such information . For 
example, Publons may verify your record as a reviewer by updatin g your profile published on its 
webservice if you have registered for such service or help editors t o identify candidate reviewers. 
Please find the details of processing in Publons ’ privacy policy https://publons.com/about/terms  
 
No 
Reviewer ’s report  
 
Title: Preoperative anthropomorphic and nutritious status and fi stula risk score for predicting 
clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy  
 
Version: 2 Date: 14 Jun 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.  
 
1. It is not easy to understand which factors the authors decide d to include in the modified 
prediction scoring system. They are only suggested in the subtitle of the Method section. Authors 
should explain why only high FRS and VATA/SMI were included in this system and PNI was 
excluded, if it is right, even though PNI &lt; 45 was also shown as an independent predictor of 
POPF. However, if PNI is included in the scoring system, that may deviate from the study aim.  
 
2. The first sentence of the Discussion does not indicate that PNI was an independent risk factor. 
If PNI i s recognized as another risk factor, this manuscript should be revised all over. In the 
conclusion sections, should clinicians not monitor those patients with PNI &lt; 45? 
 
3. In this revision, authors have included VATA, VATA/SATA, and VATA/SMI. Confounding 
between these variables is anticipated. Authors should give reasonable explanation of including 
these variables in multivariable analysis this time. Authors should also c larify how they 
determined those cut -offs. 
 
4. I don't think the flow of the current form of the second paragraph of the Introduction section is 
fine. I suggest deleting those sentences as follows.  
Among the postoperative complications, severe POPF remains  to be of utmost concern since it 
can result in massive bleeding. →This sentence should be the second of the first paragraph.  
Improvements in surgical techniques and perioperative management strategies have remarkably 
reduced the morbidity and mortality ra tes after PD, which are reportedly 15 -44% and 1 -4%, 
respectively. →Because this sentence overlaps with the first sentence of the first paragraph, 
deletion or revision is advised.  
In 2016, the International Study Group on Pancreatic 69 Fistula (ISGPF) redef ined POPF and 
recognized its prevalence at 13 -30%. →This sentence should be the third of the first paragraph. 
Then, reported risk factors of POPF should be mentioned.  
 
5. The estimated reasons of high rate of POPF should be described in the Discussion sect ion. 
 
6. Did the investigators of CT analysis not satisfy the authorship criteria?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 recommend additional statistical review  
 
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 competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, fee s, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financiall y 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 organizati on 
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 a bove, write 'I declare that I have  no competing  interests' 
below. If your reply is yes to any, please give details below.  
 
None declared.  
 
Reviewer Publication Consent. I agree for my report to be made  available under an Open 
Access Creative Commons CC -BY Li cense ( http://creativecommons.org/licenses/by/4.0 ) if this 
manuscript  is accepted for publication. Any comments that I do not wish to be included in the 
published  report have been included as confidential comments to the editor, which will not be 
published.  If you are not happy for us to publish this report, please contact the editorial office 
before completing  the review.  If you wish, you can include your name in you r published report. 
Please note you must  decide whether to include your name at the start of the process and confirm 
this decision whenever  prompted. If you change your decision later, we will not be able to 
publish your name.  
 
I agree to the terms of the C C-BY 4.0 license; please do not publish my name with my report. 
(default)  
 
Publons Reviewer Recognition . Springer Nature can send verifica tion of this review directly to 
Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of t his service, 
please click on the “Yes” option below. Your name, email  address, title of the reviewed 
manuscript, name of the journal, and date of your review submission (the “Review Data ”) will 
then be transmitted to Publons upon publication of the manuscr ipt. If you have already registered 
at Publons, they will notify you of the receipt of this review and update your profile as per your 
settings and their policy. If you are not registered with Publons,  you will re ceive an email from 
them asking you to regi ster in order for them to be able to re cognize your review on your new 
profile page. Publons may use the Review Data to generate derivat ive metadata for the benefit of 
Publons and you as a reviewer, carefully considering the sensitivity of such information . For 
example, Publons may verify your record as a reviewer by updatin g your profile published on its 
webservice if you have registered for such service or help editors t o identify candidate reviewers. 
Please find the details of processing in Publons ’ privacy policy https://publons.com/about/terms  
 
No 
Please review this paper.
user
Reviewer ’s report  
 
Title: Preoperative anthropomorphic and nutritious status and fi stula risk score for predicting 
clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy  
 
Version: 2 Date: 14 Jun 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.  
 
1. It is not easy to understand which factors the authors decide d to include in the modified 
prediction scoring system. They are only suggested in the subtitle of the Method section. Authors 
should explain why only high FRS and VATA/SMI were included in this system and PNI was 
excluded, if it is right, even though PNI &lt; 45 was also shown as an independent predictor of 
POPF. However, if PNI is included in the scoring system, that may deviate from the study aim.  
 
2. The first sentence of the Discussion does not indicate that PNI was an independent risk factor. 
If PNI i s recognized as another risk factor, this manuscript should be revised all over. In the 
conclusion sections, should clinicians not monitor those patients with PNI &lt; 45? 
 
3. In this revision, authors have included VATA, VATA/SATA, and VATA/SMI. Confounding 
between these variables is anticipated. Authors should give reasonable explanation of including 
these variables in multivariable analysis this time. Authors should also c larify how they 
determined those cut -offs. 
 
4. I don't think the flow of the current form of the second paragraph of the Introduction section is 
fine. I suggest deleting those sentences as follows.  
Among the postoperative complications, severe POPF remains  to be of utmost concern since it 
can result in massive bleeding. →This sentence should be the second of the first paragraph.  
Improvements in surgical techniques and perioperative management strategies have remarkably 
reduced the morbidity and mortality ra tes after PD, which are reportedly 15 -44% and 1 -4%, 
respectively. →Because this sentence overlaps with the first sentence of the first paragraph, 
deletion or revision is advised.  
In 2016, the International Study Group on Pancreatic 69 Fistula (ISGPF) redef ined POPF and 
recognized its prevalence at 13 -30%. →This sentence should be the third of the first paragraph. 
Then, reported risk factors of POPF should be mentioned.  
 
5. The estimated reasons of high rate of POPF should be described in the Discussion sect ion. 
 
6. Did the investigators of CT analysis not satisfy the authorship criteria?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 recommend additional statistical review  
 
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 competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, fee s, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financiall y 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 organizati on 
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 a bove, write 'I declare that I have  no competing  interests' 
below. If your reply is yes to any, please give details below.  
 
None declared.  
 
Reviewer Publication Consent. I agree for my report to be made  available under an Open 
Access Creative Commons CC -BY Li cense ( http://creativecommons.org/licenses/by/4.0 ) if this 
manuscript  is accepted for publication. Any comments that I do not wish to be included in the 
published  report have been included as confidential comments to the editor, which will not be 
published.  If you are not happy for us to publish this report, please contact the editorial office 
before completing  the review.  If you wish, you can include your name in you r published report. 
Please note you must  decide whether to include your name at the start of the process and confirm 
this decision whenever  prompted. If you change your decision later, we will not be able to 
publish your name.  
 
I agree to the terms of the C C-BY 4.0 license; please do not publish my name with my report. 
(default)  
 
Publons Reviewer Recognition . Springer Nature can send verifica tion of this review directly to 
Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of t his service, 
please click on the “Yes” option below. Your name, email  address, title of the reviewed 
manuscript, name of the journal, and date of your review submission (the “Review Data ”) will 
then be transmitted to Publons upon publication of the manuscr ipt. If you have already registered 
at Publons, they will notify you of the receipt of this review and update your profile as per your 
settings and their policy. If you are not registered with Publons,  you will re ceive an email from 
them asking you to regi ster in order for them to be able to re cognize your review on your new 
profile page. Publons may use the Review Data to generate derivat ive metadata for the benefit of 
Publons and you as a reviewer, carefully considering the sensitivity of such information . For 
example, Publons may verify your record as a reviewer by updatin g your profile published on its 
webservice if you have registered for such service or help editors t o identify candidate reviewers. 
Please find the details of processing in Publons ’ privacy policy https://publons.com/about/terms  
 
No 
assistant