Reviewer's report
Title:LDP vs ODP for pancreatic adenocarcinoma: A case matched study from a
single-institution
Version:3Date:23 July 2015
Reviewer: Claudio Ricci
Reviewer's report:
The paper focused on a very important finding. However, some suggestions
could be improve the quality of the manuscript.
Major revisions
1. Lack of the readmission rate. To correctly evaluate the differences in
postoperative course i suggest to consider the readmission rate.
2.Lack of intention to treat analysis. Patients converted in open procedure and
resected must be analyzed in LDP group. If the authors excluded this patients
from the analysis, increased the bias of the study. Please, the authors had to
clarify if 2 patients excluded from LDP group, underwent to pancreatic resection.
In this case, the authors had to be include in the analysis these cases.
3. Lack of information about postoperative management. For example, was the
ERAS protocol applied in both LDP or ODP groups ? Oral intake could be
depend more from the physician choice than a real advantage in mini-invasive
approach ! Please, the authors had to clarify the protocol used in both groups, to
correct interpretation of the results.
4. What is the experience of the surgeon in laparoscopic distal pancreatectomy ?
Have the surgeon completed the learning curve for LDP ? The operative time
and conversion rate is strictly related to this finding. Two recent papers (1.
Updates Surg. 2012 Sep;64(3):179-83. doi: 10.1007/s13304-012-0163-2. Epub
2012 Jul 5; Learning curve for laparoscopic distal pancreatectomy in a
high-volume hospital.Braga M1, Ridolfi C, Balzano G, Castoldi R, Pecorelli N, Di
Carlo V. 2. Surg Today. 2015 Jan;45(1):50-6. doi: 10.1007/s00595-014-0872-x.
Epub 2014 Mar 9.Laparoscopic distal pancreatectomy: what factors are related
to the learning curve?Ricci C1, Casadei R, Buscemi S, Taffurelli G, D'Ambra M,
Pacilio CA, Minni F.)
demonstrated the role of learning curve in LDP. Please, the authors had to
specify the experience of first surgeon, to discuss the role of learning curve in
their experiences and to add in the section "references" the two paper above
mentioned.
5. The conclusions should be "softened". This study is retrospective, with small
sample size. The "oncologic safety" is still un debate. The sentence "the short
oncologic outcomes and long term survival were similar between LDP and ODP
groups" is not supported by the data.
Minor revision
1. Report the median and range instead mean and standard deviation for
continuous variables
2. Include in Cox model: tumor differentiation and tumor stage according AJCC
3. The power of Cox model should be assess calculating Harrell C value
(c-index) in order to verify the robustness of the results.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Reviewer's report
Title:LDP vs ODP for pancreatic adenocarcinoma: A case matched study from a
single-institution
Version:3Date:23 July 2015
Reviewer: Claudio Ricci
Reviewer's report:
The paper focused on a very important finding. However, some suggestions
could be improve the quality of the manuscript.
Major revisions
1. Lack of the readmission rate. To correctly evaluate the differences in
postoperative course i suggest to consider the readmission rate.
2.Lack of intention to treat analysis. Patients converted in open procedure and
resected must be analyzed in LDP group. If the authors excluded this patients
from the analysis, increased the bias of the study. Please, the authors had to
clarify if 2 patients excluded from LDP group, underwent to pancreatic resection.
In this case, the authors had to be include in the analysis these cases.
3. Lack of information about postoperative management. For example, was the
ERAS protocol applied in both LDP or ODP groups ? Oral intake could be
depend more from the physician choice than a real advantage in mini-invasive
approach ! Please, the authors had to clarify the protocol used in both groups, to
correct interpretation of the results.
4. What is the experience of the surgeon in laparoscopic distal pancreatectomy ?
Have the surgeon completed the learning curve for LDP ? The operative time
and conversion rate is strictly related to this finding. Two recent papers (1.
Updates Surg. 2012 Sep;64(3):179-83. doi: 10.1007/s13304-012-0163-2. Epub
2012 Jul 5; Learning curve for laparoscopic distal pancreatectomy in a
high-volume hospital.Braga M1, Ridolfi C, Balzano G, Castoldi R, Pecorelli N, Di
Carlo V. 2. Surg Today. 2015 Jan;45(1):50-6. doi: 10.1007/s00595-014-0872-x.
Epub 2014 Mar 9.Laparoscopic distal pancreatectomy: what factors are related
to the learning curve?Ricci C1, Casadei R, Buscemi S, Taffurelli G, D'Ambra M,
Pacilio CA, Minni F.)
demonstrated the role of learning curve in LDP. Please, the authors had to
specify the experience of first surgeon, to discuss the role of learning curve in
their experiences and to add in the section "references" the two paper above
mentioned.
5. The conclusions should be "softened". This study is retrospective, with small
sample size. The "oncologic safety" is still un debate. The sentence "the short
oncologic outcomes and long term survival were similar between LDP and ODP
groups" is not supported by the data.
Minor revision
1. Report the median and range instead mean and standard deviation for
continuous variables
2. Include in Cox model: tumor differentiation and tumor stage according AJCC
3. The power of Cox model should be assess calculating Harrell C value
(c-index) in order to verify the robustness of the results.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Please review this paper.
user
Reviewer's report
Title:LDP vs ODP for pancreatic adenocarcinoma: A case matched study from a
single-institution
Version:3Date:23 July 2015
Reviewer: Claudio Ricci
Reviewer's report:
The paper focused on a very important finding. However, some suggestions
could be improve the quality of the manuscript.
Major revisions
1. Lack of the readmission rate. To correctly evaluate the differences in
postoperative course i suggest to consider the readmission rate.
2.Lack of intention to treat analysis. Patients converted in open procedure and
resected must be analyzed in LDP group. If the authors excluded this patients
from the analysis, increased the bias of the study. Please, the authors had to
clarify if 2 patients excluded from LDP group, underwent to pancreatic resection.
In this case, the authors had to be include in the analysis these cases.
3. Lack of information about postoperative management. For example, was the
ERAS protocol applied in both LDP or ODP groups ? Oral intake could be
depend more from the physician choice than a real advantage in mini-invasive
approach ! Please, the authors had to clarify the protocol used in both groups, to
correct interpretation of the results.
4. What is the experience of the surgeon in laparoscopic distal pancreatectomy ?
Have the surgeon completed the learning curve for LDP ? The operative time
and conversion rate is strictly related to this finding. Two recent papers (1.
Updates Surg. 2012 Sep;64(3):179-83. doi: 10.1007/s13304-012-0163-2. Epub
2012 Jul 5; Learning curve for laparoscopic distal pancreatectomy in a
high-volume hospital.Braga M1, Ridolfi C, Balzano G, Castoldi R, Pecorelli N, Di
Carlo V. 2. Surg Today. 2015 Jan;45(1):50-6. doi: 10.1007/s00595-014-0872-x.
Epub 2014 Mar 9.Laparoscopic distal pancreatectomy: what factors are related
to the learning curve?Ricci C1, Casadei R, Buscemi S, Taffurelli G, D'Ambra M,
Pacilio CA, Minni F.)
demonstrated the role of learning curve in LDP. Please, the authors had to
specify the experience of first surgeon, to discuss the role of learning curve in
their experiences and to add in the section "references" the two paper above
mentioned.
5. The conclusions should be "softened". This study is retrospective, with small
sample size. The "oncologic safety" is still un debate. The sentence "the short
oncologic outcomes and long term survival were similar between LDP and ODP
groups" is not supported by the data.
Minor revision
1. Report the median and range instead mean and standard deviation for
continuous variables
2. Include in Cox model: tumor differentiation and tumor stage according AJCC
3. The power of Cox model should be assess calculating Harrell C value
(c-index) in order to verify the robustness of the results.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
assistant