Reviewer ’s report  
 
Title: Preoperative anthropomorphic and nutritious status and fi stula risk score for predicting 
clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy  
 
Version: 1 Date: 01 Mar 2020  
 
Reviewer: Manabu Kawai  
 
Reviewer's report:  
 
This manuscript was written about the impact of the efficacy of the combination of fistula risk  
score (FRS) and preoperative body compo sition factors to predict clinically relevant pancreatic 
fistula. This manuscript states some important issues regarding rusk factors to predict pancreatic 
fistula after pancreatectomy. However further discussion and analysis would be required to 
confirm t his conclusion Therefore, authors would clarify several matters that mentioned below.  
 
1. Were there significant differences between each body composition factor such as 
visceral adipose tissue area (VATA), skeletal mass index (SMI), or subcutaneous adipos e tissue 
area (SATA) and occurrence of clinically relevant pancreatic fistula, although the ratios of 
VATA/SMI or VATA/SATA had impact to predict pancreatic fistula? Authors could evaluate 
the association between each body composition factor and occurrence  of clinically relevant 
pancreatic fistula by univariate analysis in Table 2.  
 
2. Authors reported VATA/SMI metric may be useful for a more precise evaluation of 
visceral fatty tissue and skeletal muscle imbalance. However, what was the correlation between  
VATA and SMI? It remains still unclear how VATA/SMI ratio have a prominent impact to 
predict pancreatic fistula. Authors could clearly explain why VATA/SMI ratio to predict 
pancreatic fistula is more important compared to each body composition factor.  
 
3. This study includes patients with pancreatic cancer. Was neoadjuvant therapy 
administrated for some of patients with pancreatic cancer? Neoadjuvant therapy sometimes 
adversely affected preoperative nutrition status. If neoadjuvant therapy was administrate d, how 
were preoperative body composition factors affected by neoadjuvant therapy?  
 
4. The results of multivariate analysis for PNI &lt;45, soft pancreas, or pancreatic duct 
size&lt;3mm lacked in Table 2. Authors could bring Table 2 to completion.  
 
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 comme nts to the authors.  
 
Yes 
 
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 qua lity 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 salar y 
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 financially from the publicati on 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 re ceived 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 decla re 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 repo rt to the authors and, if the manuscript is accepted f or publication, my named 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://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: Preoperative anthropomorphic and nutritious status and fi stula risk score for predicting 
clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy  
 
Version: 1 Date: 01 Mar 2020  
 
Reviewer: Manabu Kawai  
 
Reviewer's report:  
 
This manuscript was written about the impact of the efficacy of the combination of fistula risk  
score (FRS) and preoperative body compo sition factors to predict clinically relevant pancreatic 
fistula. This manuscript states some important issues regarding rusk factors to predict pancreatic 
fistula after pancreatectomy. However further discussion and analysis would be required to 
confirm t his conclusion Therefore, authors would clarify several matters that mentioned below.  
 
1. Were there significant differences between each body composition factor such as 
visceral adipose tissue area (VATA), skeletal mass index (SMI), or subcutaneous adipos e tissue 
area (SATA) and occurrence of clinically relevant pancreatic fistula, although the ratios of 
VATA/SMI or VATA/SATA had impact to predict pancreatic fistula? Authors could evaluate 
the association between each body composition factor and occurrence  of clinically relevant 
pancreatic fistula by univariate analysis in Table 2.  
 
2. Authors reported VATA/SMI metric may be useful for a more precise evaluation of 
visceral fatty tissue and skeletal muscle imbalance. However, what was the correlation between  
VATA and SMI? It remains still unclear how VATA/SMI ratio have a prominent impact to 
predict pancreatic fistula. Authors could clearly explain why VATA/SMI ratio to predict 
pancreatic fistula is more important compared to each body composition factor.  
 
3. This study includes patients with pancreatic cancer. Was neoadjuvant therapy 
administrated for some of patients with pancreatic cancer? Neoadjuvant therapy sometimes 
adversely affected preoperative nutrition status. If neoadjuvant therapy was administrate d, how 
were preoperative body composition factors affected by neoadjuvant therapy?  
 
4. The results of multivariate analysis for PNI &lt;45, soft pancreas, or pancreatic duct 
size&lt;3mm lacked in Table 2. Authors could bring Table 2 to completion.  
 
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 comme nts to the authors.  
 
Yes 
 
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 qua lity 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 salar y 
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 financially from the publicati on 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 re ceived 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 decla re 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 repo rt to the authors and, if the manuscript is accepted f or publication, my named 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://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: Preoperative anthropomorphic and nutritious status and fi stula risk score for predicting 
clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy  
 
Version: 1 Date: 01 Mar 2020  
 
Reviewer: Manabu Kawai  
 
Reviewer's report:  
 
This manuscript was written about the impact of the efficacy of the combination of fistula risk  
score (FRS) and preoperative body compo sition factors to predict clinically relevant pancreatic 
fistula. This manuscript states some important issues regarding rusk factors to predict pancreatic 
fistula after pancreatectomy. However further discussion and analysis would be required to 
confirm t his conclusion Therefore, authors would clarify several matters that mentioned below.  
 
1. Were there significant differences between each body composition factor such as 
visceral adipose tissue area (VATA), skeletal mass index (SMI), or subcutaneous adipos e tissue 
area (SATA) and occurrence of clinically relevant pancreatic fistula, although the ratios of 
VATA/SMI or VATA/SATA had impact to predict pancreatic fistula? Authors could evaluate 
the association between each body composition factor and occurrence  of clinically relevant 
pancreatic fistula by univariate analysis in Table 2.  
 
2. Authors reported VATA/SMI metric may be useful for a more precise evaluation of 
visceral fatty tissue and skeletal muscle imbalance. However, what was the correlation between  
VATA and SMI? It remains still unclear how VATA/SMI ratio have a prominent impact to 
predict pancreatic fistula. Authors could clearly explain why VATA/SMI ratio to predict 
pancreatic fistula is more important compared to each body composition factor.  
 
3. This study includes patients with pancreatic cancer. Was neoadjuvant therapy 
administrated for some of patients with pancreatic cancer? Neoadjuvant therapy sometimes 
adversely affected preoperative nutrition status. If neoadjuvant therapy was administrate d, how 
were preoperative body composition factors affected by neoadjuvant therapy?  
 
4. The results of multivariate analysis for PNI &lt;45, soft pancreas, or pancreatic duct 
size&lt;3mm lacked in Table 2. Authors could bring Table 2 to completion.  
 
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 comme nts to the authors.  
 
Yes 
 
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 qua lity 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 salar y 
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 financially from the publicati on 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 re ceived 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 decla re 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 repo rt to the authors and, if the manuscript is accepted f or publication, my named 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://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