Reviewer ’s report  
 
Title: Predictors of unexpected metastasis on exploration in patients with potentially resectable 
pancreatic cancer  
 
Version: 1 Date: 13 Sep 2018  
 
Reviewer: Kimberly J. Perez  
 
Reviewer's report:  
 
This is a very interesting retrospective analysis of patients with radiographic evidence of 
resectable disease. It raised many questions for me. I agree that we need to identify a scoring 
system or risk assessment for patients we consider resectable but as you described this scoring 
system really only applie d to visible metastatic disease and not micrometastatic disease. Do you 
have any data regarding your patients that were resected and demonstrated radiographic disease 
within 6 months of resection? I think it would be interesting to apply your scoring syste m to 
patients who recurred after resection (different intervals - 3,6,9,12, >12 months vs those who had 
not yet progressed). I think it is those patients with micrometastatic disease that you would like 
to identify, especially those that recur in a short i nterval. Also, did any of your patients receive 
neoadjuvant chemotherapy. This has become more standard practice, further supported by the 
data presented at ASCO 2018.  
So, although I believe you present a well thought out, conducted study, I am not sure how this 
data impacts current practice. It acknowledges an issue that is well known. I think that the 
current practice of neoadjuvant therapy and consideration of micrometastatic disease needs to 
also be considered in your analysis.  
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 comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
  
Are you able to assess any st atistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statisti cs 
 
Quality of written English  
Please indicate the quality 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 y ears received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may i n any way gain or lose  
financially from the publication 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 received reimbursements, fees, fund ing, 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 declare 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 report to the authors and, if the manuscript is accepted for 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: Predictors of unexpected metastasis on exploration in patients with potentially resectable 
pancreatic cancer  
 
Version: 1 Date: 13 Sep 2018  
 
Reviewer: Kimberly J. Perez  
 
Reviewer's report:  
 
This is a very interesting retrospective analysis of patients with radiographic evidence of 
resectable disease. It raised many questions for me. I agree that we need to identify a scoring 
system or risk assessment for patients we consider resectable but as you described this scoring 
system really only applie d to visible metastatic disease and not micrometastatic disease. Do you 
have any data regarding your patients that were resected and demonstrated radiographic disease 
within 6 months of resection? I think it would be interesting to apply your scoring syste m to 
patients who recurred after resection (different intervals - 3,6,9,12, >12 months vs those who had 
not yet progressed). I think it is those patients with micrometastatic disease that you would like 
to identify, especially those that recur in a short i nterval. Also, did any of your patients receive 
neoadjuvant chemotherapy. This has become more standard practice, further supported by the 
data presented at ASCO 2018.  
So, although I believe you present a well thought out, conducted study, I am not sure how this 
data impacts current practice. It acknowledges an issue that is well known. I think that the 
current practice of neoadjuvant therapy and consideration of micrometastatic disease needs to 
also be considered in your analysis.  
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 comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
  
Are you able to assess any st atistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statisti cs 
 
Quality of written English  
Please indicate the quality 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 y ears received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may i n any way gain or lose  
financially from the publication 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 received reimbursements, fees, fund ing, 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 declare 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 report to the authors and, if the manuscript is accepted for 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: Predictors of unexpected metastasis on exploration in patients with potentially resectable 
pancreatic cancer  
 
Version: 1 Date: 13 Sep 2018  
 
Reviewer: Kimberly J. Perez  
 
Reviewer's report:  
 
This is a very interesting retrospective analysis of patients with radiographic evidence of 
resectable disease. It raised many questions for me. I agree that we need to identify a scoring 
system or risk assessment for patients we consider resectable but as you described this scoring 
system really only applie d to visible metastatic disease and not micrometastatic disease. Do you 
have any data regarding your patients that were resected and demonstrated radiographic disease 
within 6 months of resection? I think it would be interesting to apply your scoring syste m to 
patients who recurred after resection (different intervals - 3,6,9,12, >12 months vs those who had 
not yet progressed). I think it is those patients with micrometastatic disease that you would like 
to identify, especially those that recur in a short i nterval. Also, did any of your patients receive 
neoadjuvant chemotherapy. This has become more standard practice, further supported by the 
data presented at ASCO 2018.  
So, although I believe you present a well thought out, conducted study, I am not sure how this 
data impacts current practice. It acknowledges an issue that is well known. I think that the 
current practice of neoadjuvant therapy and consideration of micrometastatic disease needs to 
also be considered in your analysis.  
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 comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
  
Are you able to assess any st atistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statisti cs 
 
Quality of written English  
Please indicate the quality 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 y ears received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may i n any way gain or lose  
financially from the publication 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 received reimbursements, fees, fund ing, 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 declare 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 report to the authors and, if the manuscript is accepted for 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