Reviewer ’s report  
 
Title: Expanding Laparoscopic Pancreaticoduodenectomy to Pancreatic -Head and Periampullary 
Malignancy: Major Findings Based on Systematic Review and Meta -analysis  
 
Version: 1 Date: 17 Jun 2018  
 
Reviewer: Giovanni Capretti  
 
Reviewer's report:  
 
Dear authors,  
 
I really appreciate your work on the manuscript and I think it had been improved. Unfor tunately 
I still have some concerns:  
- Major :  You state that margins were considered R0 when no tumor was evident along the 
transaction surface. But at least in one of your analyzed work (Hakeem) the R0 definition 
was neoplastic cells at less than 1 mm to  the transaction margin. This raises some concern in 
your methods sections. Have you uniformed all the fistula and R0 definitions? If yes how? If 
no this heterogeneity in the definition of the outcomes could further undermine the solidity of 
your work and you have to state it  
 
- Minors : Why in your string do you listed also the robotic approach? It could be interesting to 
have also a comparison of the results of this minimally invasive way to perform a PD, why 
do you choose to analyze only laparoscopic PD?  
Best regards  
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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire 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:  
 
Acceptable  
 
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, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, eithe r now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 r elating 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 inter ests?  
 
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 understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any att achments 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://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do  not wish to be included in my named report can be included 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: Expanding Laparoscopic Pancreaticoduodenectomy to Pancreatic -Head and Periampullary 
Malignancy: Major Findings Based on Systematic Review and Meta -analysis  
 
Version: 1 Date: 17 Jun 2018  
 
Reviewer: Giovanni Capretti  
 
Reviewer's report:  
 
Dear authors,  
 
I really appreciate your work on the manuscript and I think it had been improved. Unfor tunately 
I still have some concerns:  
- Major :  You state that margins were considered R0 when no tumor was evident along the 
transaction surface. But at least in one of your analyzed work (Hakeem) the R0 definition 
was neoplastic cells at less than 1 mm to  the transaction margin. This raises some concern in 
your methods sections. Have you uniformed all the fistula and R0 definitions? If yes how? If 
no this heterogeneity in the definition of the outcomes could further undermine the solidity of 
your work and you have to state it  
 
- Minors : Why in your string do you listed also the robotic approach? It could be interesting to 
have also a comparison of the results of this minimally invasive way to perform a PD, why 
do you choose to analyze only laparoscopic PD?  
Best regards  
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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire 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:  
 
Acceptable  
 
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, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, eithe r now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 r elating 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 inter ests?  
 
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 understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any att achments 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://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do  not wish to be included in my named report can be included 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: Expanding Laparoscopic Pancreaticoduodenectomy to Pancreatic -Head and Periampullary 
Malignancy: Major Findings Based on Systematic Review and Meta -analysis  
 
Version: 1 Date: 17 Jun 2018  
 
Reviewer: Giovanni Capretti  
 
Reviewer's report:  
 
Dear authors,  
 
I really appreciate your work on the manuscript and I think it had been improved. Unfor tunately 
I still have some concerns:  
- Major :  You state that margins were considered R0 when no tumor was evident along the 
transaction surface. But at least in one of your analyzed work (Hakeem) the R0 definition 
was neoplastic cells at less than 1 mm to  the transaction margin. This raises some concern in 
your methods sections. Have you uniformed all the fistula and R0 definitions? If yes how? If 
no this heterogeneity in the definition of the outcomes could further undermine the solidity of 
your work and you have to state it  
 
- Minors : Why in your string do you listed also the robotic approach? It could be interesting to 
have also a comparison of the results of this minimally invasive way to perform a PD, why 
do you choose to analyze only laparoscopic PD?  
Best regards  
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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire 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:  
 
Acceptable  
 
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, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, eithe r now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 r elating 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 inter ests?  
 
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 understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any att achments 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://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do  not wish to be included in my named report can be included as confidential comments 
to the  editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant