Title: Surgical treatment of chronic pancreatitis with an inflammatory pancreatic head mass: a
retrospective study
Version: 1 Date: 21 May 2024
Reviewer's report:
The authors present a retrospective short-term analysis of 61 patients undergoing surgery
for advanced chronic pancreatitis, comparing postoperative short-term results of 38 patients
following PD with 28 patients following DPPHR.
They concluded that both surgical techniques are safe treatment options. The parenchyma-
sparing pancreatic head resection, DPPHR was superior in terms of shorter operation time,
however most intra- and postoperative parameters were observed equally frequent. This
retrospective analysis is based on a very small patient group. The message for surgical decision-
making to choose the best procedure could be improved by presenting more detailed analytic
data.
1a. What was the frequency of reintervention in both groups of patients (Radiologic management
of arterial bleeding, interventional abscess drainage, biliary stenting, endoscopic intervention)
hidden in Table 3:  CD III+ (32 % vs. 35 % respectively PDE vs. DPPHR)?
1b. How many patients were discharged with drainage of a biliary fistula in situ in both groups?
1c. The frequency of re-laparotomy is unusually high with 18 % PDE and 23 % DPPHR. More
convincing are data about indication of relaparotomy in the 7 and 5 patients respectively.
1d. What was the frequency of 90-day rehospitalisation in both groups?
2. How many patients suffered cancer in the pancreatic head with inflammatory head tumor
in both groups of patients?
3. To include Frey procedure in the DPPHR is incorrect, since Frey procedure is a modification
of Partington-Rochelle with coring out of some preductal pancreatic head tissue.
4. The Cochrane meta-analysis of randomized trials (Cochrane database systematic review 2016)
is overestimated. Its evidence is low because of inclusion of trials with several modifications
of DPPHR (Frey procedure, Izbicki-technique) and two PDs: Whipple procedure and PPPD in
the group of PD.
5. The authors did not consider the long-term outcome after PD and DPPHR in terms
of metabolic complications, e. g. new onset of diabetes mellitus, new onset of exocrine
insufficiency with the need of life-long medical enzyme supplementation.
Long-term observation after PD and DPPHR for chronic pancreatitis revealed a significant
shorter long-term survival after 15 years following PD compared to DPPHR (Ann Surg 2013;
258 (5): 815-).
In the present form of data analysis, the message of the manuscript is limited.
Title: Surgical treatment of chronic pancreatitis with an inflammatory pancreatic head mass: a
retrospective study
Version: 1 Date: 21 May 2024
Reviewer's report:
The authors present a retrospective short-term analysis of 61 patients undergoing surgery
for advanced chronic pancreatitis, comparing postoperative short-term results of 38 patients
following PD with 28 patients following DPPHR.
They concluded that both surgical techniques are safe treatment options. The parenchyma-
sparing pancreatic head resection, DPPHR was superior in terms of shorter operation time,
however most intra- and postoperative parameters were observed equally frequent. This
retrospective analysis is based on a very small patient group. The message for surgical decision-
making to choose the best procedure could be improved by presenting more detailed analytic
data.
1a. What was the frequency of reintervention in both groups of patients (Radiologic management
of arterial bleeding, interventional abscess drainage, biliary stenting, endoscopic intervention)
hidden in Table 3:  CD III+ (32 % vs. 35 % respectively PDE vs. DPPHR)?
1b. How many patients were discharged with drainage of a biliary fistula in situ in both groups?
1c. The frequency of re-laparotomy is unusually high with 18 % PDE and 23 % DPPHR. More
convincing are data about indication of relaparotomy in the 7 and 5 patients respectively.
1d. What was the frequency of 90-day rehospitalisation in both groups?
2. How many patients suffered cancer in the pancreatic head with inflammatory head tumor
in both groups of patients?
3. To include Frey procedure in the DPPHR is incorrect, since Frey procedure is a modification
of Partington-Rochelle with coring out of some preductal pancreatic head tissue.
4. The Cochrane meta-analysis of randomized trials (Cochrane database systematic review 2016)
is overestimated. Its evidence is low because of inclusion of trials with several modifications
of DPPHR (Frey procedure, Izbicki-technique) and two PDs: Whipple procedure and PPPD in
the group of PD.
5. The authors did not consider the long-term outcome after PD and DPPHR in terms
of metabolic complications, e. g. new onset of diabetes mellitus, new onset of exocrine
insufficiency with the need of life-long medical enzyme supplementation.
Long-term observation after PD and DPPHR for chronic pancreatitis revealed a significant
shorter long-term survival after 15 years following PD compared to DPPHR (Ann Surg 2013;
258 (5): 815-).
In the present form of data analysis, the message of the manuscript is limited.
Please review this paper.
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Title: Surgical treatment of chronic pancreatitis with an inflammatory pancreatic head mass: a
retrospective study
Version: 1 Date: 21 May 2024
Reviewer's report:
The authors present a retrospective short-term analysis of 61 patients undergoing surgery
for advanced chronic pancreatitis, comparing postoperative short-term results of 38 patients
following PD with 28 patients following DPPHR.
They concluded that both surgical techniques are safe treatment options. The parenchyma-
sparing pancreatic head resection, DPPHR was superior in terms of shorter operation time,
however most intra- and postoperative parameters were observed equally frequent. This
retrospective analysis is based on a very small patient group. The message for surgical decision-
making to choose the best procedure could be improved by presenting more detailed analytic
data.
1a. What was the frequency of reintervention in both groups of patients (Radiologic management
of arterial bleeding, interventional abscess drainage, biliary stenting, endoscopic intervention)
hidden in Table 3:  CD III+ (32 % vs. 35 % respectively PDE vs. DPPHR)?
1b. How many patients were discharged with drainage of a biliary fistula in situ in both groups?
1c. The frequency of re-laparotomy is unusually high with 18 % PDE and 23 % DPPHR. More
convincing are data about indication of relaparotomy in the 7 and 5 patients respectively.
1d. What was the frequency of 90-day rehospitalisation in both groups?
2. How many patients suffered cancer in the pancreatic head with inflammatory head tumor
in both groups of patients?
3. To include Frey procedure in the DPPHR is incorrect, since Frey procedure is a modification
of Partington-Rochelle with coring out of some preductal pancreatic head tissue.
4. The Cochrane meta-analysis of randomized trials (Cochrane database systematic review 2016)
is overestimated. Its evidence is low because of inclusion of trials with several modifications
of DPPHR (Frey procedure, Izbicki-technique) and two PDs: Whipple procedure and PPPD in
the group of PD.
5. The authors did not consider the long-term outcome after PD and DPPHR in terms
of metabolic complications, e. g. new onset of diabetes mellitus, new onset of exocrine
insufficiency with the need of life-long medical enzyme supplementation.
Long-term observation after PD and DPPHR for chronic pancreatitis revealed a significant
shorter long-term survival after 15 years following PD compared to DPPHR (Ann Surg 2013;
258 (5): 815-).
In the present form of data analysis, the message of the manuscript is limited.
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