Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 3 Date: 02 Jun 2024
Reviewer:  Gaurav Das
Reviewer's report:
1. Abstract, results section 5th line. “The mean overall 30-day survival for all patients was
27.6 days”. This sentence does not make sense to me. The same has been described in the
postoperative course sub-section of results section of the main manuscript. This is followed by a
statement that palliation failure was associated with a mean survival of 11.3 days. These results
are certainly not properly conveyed or else there is a problem with the sample population.
2. Introduction section, paragraph 4. I do not agree to the statement that the survival of
unresectable pancreatic cancer is 3 to 6 months (I do understand that published literature says
that 5-year survival is less than 5%). The disease may be “unresectable” but non-metastatic
and belong to the locally advanced group of cancers which are treated with definite strategies
(systemic treatment, chemoradiation, SBRT etc.)
3. Patients and methods section; sample size and sampling sub-section. “34 patients did not meet
the inclusion criteria”. Can you kindly elaborate on the exclusion criteria? The first paragraph is
unclear regarding what was taken as “unresectability” in the inclusion criteria. In the discussion
section, I do note that all the patients had T4 stage according to the TNM 8th ed.
4. Discussion section 7. The most common imaging modality described is an ultrasound (66%).
Can the authors describe whether an ultrasound will be a sufficient investigation to rule in or
out a locally advanced head of pancreas cancer? The use of a triple-phase contrast computed
tomography (pancreatic protocol) is the standard for assessment of resectability of pancreatic
cancers.
5. A 30-day mortality figure of 13.2% and a palliation failure rate of 22.6% does not show an
encouraging outcome with this palliative procedure for the patient population described in the
study. What are the steps that could be taken to improve upon these figures?
6. Did the patients receive any cancer-directed therapy apart from the palliative diversion
procedures?
Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 3 Date: 02 Jun 2024
Reviewer:  Gaurav Das
Reviewer's report:
1. Abstract, results section 5th line. “The mean overall 30-day survival for all patients was
27.6 days”. This sentence does not make sense to me. The same has been described in the
postoperative course sub-section of results section of the main manuscript. This is followed by a
statement that palliation failure was associated with a mean survival of 11.3 days. These results
are certainly not properly conveyed or else there is a problem with the sample population.
2. Introduction section, paragraph 4. I do not agree to the statement that the survival of
unresectable pancreatic cancer is 3 to 6 months (I do understand that published literature says
that 5-year survival is less than 5%). The disease may be “unresectable” but non-metastatic
and belong to the locally advanced group of cancers which are treated with definite strategies
(systemic treatment, chemoradiation, SBRT etc.)
3. Patients and methods section; sample size and sampling sub-section. “34 patients did not meet
the inclusion criteria”. Can you kindly elaborate on the exclusion criteria? The first paragraph is
unclear regarding what was taken as “unresectability” in the inclusion criteria. In the discussion
section, I do note that all the patients had T4 stage according to the TNM 8th ed.
4. Discussion section 7. The most common imaging modality described is an ultrasound (66%).
Can the authors describe whether an ultrasound will be a sufficient investigation to rule in or
out a locally advanced head of pancreas cancer? The use of a triple-phase contrast computed
tomography (pancreatic protocol) is the standard for assessment of resectability of pancreatic
cancers.
5. A 30-day mortality figure of 13.2% and a palliation failure rate of 22.6% does not show an
encouraging outcome with this palliative procedure for the patient population described in the
study. What are the steps that could be taken to improve upon these figures?
6. Did the patients receive any cancer-directed therapy apart from the palliative diversion
procedures?
Please review this paper.
user
Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 3 Date: 02 Jun 2024
Reviewer:  Gaurav Das
Reviewer's report:
1. Abstract, results section 5th line. “The mean overall 30-day survival for all patients was
27.6 days”. This sentence does not make sense to me. The same has been described in the
postoperative course sub-section of results section of the main manuscript. This is followed by a
statement that palliation failure was associated with a mean survival of 11.3 days. These results
are certainly not properly conveyed or else there is a problem with the sample population.
2. Introduction section, paragraph 4. I do not agree to the statement that the survival of
unresectable pancreatic cancer is 3 to 6 months (I do understand that published literature says
that 5-year survival is less than 5%). The disease may be “unresectable” but non-metastatic
and belong to the locally advanced group of cancers which are treated with definite strategies
(systemic treatment, chemoradiation, SBRT etc.)
3. Patients and methods section; sample size and sampling sub-section. “34 patients did not meet
the inclusion criteria”. Can you kindly elaborate on the exclusion criteria? The first paragraph is
unclear regarding what was taken as “unresectability” in the inclusion criteria. In the discussion
section, I do note that all the patients had T4 stage according to the TNM 8th ed.
4. Discussion section 7. The most common imaging modality described is an ultrasound (66%).
Can the authors describe whether an ultrasound will be a sufficient investigation to rule in or
out a locally advanced head of pancreas cancer? The use of a triple-phase contrast computed
tomography (pancreatic protocol) is the standard for assessment of resectability of pancreatic
cancers.
5. A 30-day mortality figure of 13.2% and a palliation failure rate of 22.6% does not show an
encouraging outcome with this palliative procedure for the patient population described in the
study. What are the steps that could be taken to improve upon these figures?
6. Did the patients receive any cancer-directed therapy apart from the palliative diversion
procedures?
assistant