Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 7 Date: 30 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-Although Eastern Africa’s incidence is mentioned, the study could further highlight the
healthcare infrastructure challenges specific to Tanzania or similar low-income regions. For
example, addressing issues like access to surgical interventions, stent placement, or diagnostic
imaging would provide more context on the barriers to care.
-While the study defines palliation failure well, it would be helpful to further clarify how this
impacts post-surgical management. For instance, are patients with palliation failure considered
for other interventions or supportive care only? Also, how is this failure managed in the context
of limited resources?
-While the mean surgery duration (178.5 minutes) and blood loss (77.2 ml median) provide
useful insight into the complexity and safety of the procedures, it would be valuable to compare
these metrics with other studies to contextualize the results. Was the surgery duration typical
for such procedures in a low-resource setting?
-The discussion mentions the discrepancy in the proportion of patients with locally advanced
versus metastatic disease when comparing this study to Pencovich’s research. However, it
would be helpful to provide more insight into why this difference exists. For example, is it due
to differences in diagnostic capabilities, referral patterns, or patient demographics? Exploring
this in more depth could enhance the understanding of how healthcare systems and patient
characteristics influence disease progression and management.
-While palliation failure was observed in 22.6% of patients, the discussion could provide more
specific insights into the underlying causes of palliation failure. Was it primarily due to persistent
gastric outlet obstruction (GOO), biliary issues, or both? Were any complications directly
contributing to palliation failure (e.g., anastomotic leaks, infections)? More detailed information
could help guide future interventions to improve palliation success rates.
-Furthermore, it would be useful to compare these results with those from other settings (e.g.,
high-income countries) where the management of advanced pancreatic cancer might differ,
particularly in terms of postoperative care and follow-up protocols.
-The study highlights that 81.1% of patients were uninsured, indicating a significant
socioeconomic barrier to accessing timely care. While this point is important, the discussion
could delve deeper into how the lack of insurance and low socioeconomic status impacted both
diagnosis and treatment. For example, did patients wait longer to seek care due to financial
constraints, or were there delays in referrals for advanced imaging or surgical interventions?
Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 7 Date: 30 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-Although Eastern Africa’s incidence is mentioned, the study could further highlight the
healthcare infrastructure challenges specific to Tanzania or similar low-income regions. For
example, addressing issues like access to surgical interventions, stent placement, or diagnostic
imaging would provide more context on the barriers to care.
-While the study defines palliation failure well, it would be helpful to further clarify how this
impacts post-surgical management. For instance, are patients with palliation failure considered
for other interventions or supportive care only? Also, how is this failure managed in the context
of limited resources?
-While the mean surgery duration (178.5 minutes) and blood loss (77.2 ml median) provide
useful insight into the complexity and safety of the procedures, it would be valuable to compare
these metrics with other studies to contextualize the results. Was the surgery duration typical
for such procedures in a low-resource setting?
-The discussion mentions the discrepancy in the proportion of patients with locally advanced
versus metastatic disease when comparing this study to Pencovich’s research. However, it
would be helpful to provide more insight into why this difference exists. For example, is it due
to differences in diagnostic capabilities, referral patterns, or patient demographics? Exploring
this in more depth could enhance the understanding of how healthcare systems and patient
characteristics influence disease progression and management.
-While palliation failure was observed in 22.6% of patients, the discussion could provide more
specific insights into the underlying causes of palliation failure. Was it primarily due to persistent
gastric outlet obstruction (GOO), biliary issues, or both? Were any complications directly
contributing to palliation failure (e.g., anastomotic leaks, infections)? More detailed information
could help guide future interventions to improve palliation success rates.
-Furthermore, it would be useful to compare these results with those from other settings (e.g.,
high-income countries) where the management of advanced pancreatic cancer might differ,
particularly in terms of postoperative care and follow-up protocols.
-The study highlights that 81.1% of patients were uninsured, indicating a significant
socioeconomic barrier to accessing timely care. While this point is important, the discussion
could delve deeper into how the lack of insurance and low socioeconomic status impacted both
diagnosis and treatment. For example, did patients wait longer to seek care due to financial
constraints, or were there delays in referrals for advanced imaging or surgical interventions?
Please review this paper.
user
Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 7 Date: 30 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-Although Eastern Africa’s incidence is mentioned, the study could further highlight the
healthcare infrastructure challenges specific to Tanzania or similar low-income regions. For
example, addressing issues like access to surgical interventions, stent placement, or diagnostic
imaging would provide more context on the barriers to care.
-While the study defines palliation failure well, it would be helpful to further clarify how this
impacts post-surgical management. For instance, are patients with palliation failure considered
for other interventions or supportive care only? Also, how is this failure managed in the context
of limited resources?
-While the mean surgery duration (178.5 minutes) and blood loss (77.2 ml median) provide
useful insight into the complexity and safety of the procedures, it would be valuable to compare
these metrics with other studies to contextualize the results. Was the surgery duration typical
for such procedures in a low-resource setting?
-The discussion mentions the discrepancy in the proportion of patients with locally advanced
versus metastatic disease when comparing this study to Pencovich’s research. However, it
would be helpful to provide more insight into why this difference exists. For example, is it due
to differences in diagnostic capabilities, referral patterns, or patient demographics? Exploring
this in more depth could enhance the understanding of how healthcare systems and patient
characteristics influence disease progression and management.
-While palliation failure was observed in 22.6% of patients, the discussion could provide more
specific insights into the underlying causes of palliation failure. Was it primarily due to persistent
gastric outlet obstruction (GOO), biliary issues, or both? Were any complications directly
contributing to palliation failure (e.g., anastomotic leaks, infections)? More detailed information
could help guide future interventions to improve palliation success rates.
-Furthermore, it would be useful to compare these results with those from other settings (e.g.,
high-income countries) where the management of advanced pancreatic cancer might differ,
particularly in terms of postoperative care and follow-up protocols.
-The study highlights that 81.1% of patients were uninsured, indicating a significant
socioeconomic barrier to accessing timely care. While this point is important, the discussion
could delve deeper into how the lack of insurance and low socioeconomic status impacted both
diagnosis and treatment. For example, did patients wait longer to seek care due to financial
constraints, or were there delays in referrals for advanced imaging or surgical interventions?
assistant