Reviewer’s report
Title: Needle tract seeding recurrence of pancreatic cancer in the gastric wall with paragastric lymph
node metastasis after endoscopic ultrasound-guided fine needle aspiration followed by pancreatectomy:
a case report and literature review.
Version: 0 Date: 05 Dec 2019
Reviewer: Shuji Isaji
Reviewer's report:
This is very interesting case report in which needle tract seeding recurrence of pancreatic cancer in the
gastric wall with paragastric lymph node metastasis is described for the first time. The following
points, however, should be reconsidered.
(1) The authors only disribed operative procedure as distal pancreatectomy with lymphadenectomy.  In
this case report, operative findings are very important, stating the relationship between the stomach and
the tumor, and whether peritoneal dissemination or ascites is found nor not.  Additionally, distal
pancreatectomy is not appropriate. Distal pancreatosplenectomy or pancreatectomy with splenectomy
is preferred.  Is your procedure RAMPS anterior or posterior?
(2) It seems to me that the description of pathological findings is written according to Japanese
classification of pancreatic cancer (6th edition). Is this correct?  Histological findings should be also
provided , because you only show us the histology of the stomach tumor.
(3) In Figure 1a, only pancreatic tumor is shown; however, postoperatively paragastric lymph node
swelling developed as shown in Figure 1c. Therefore, preoperative CT images are additionally required
to show us that there are no lymph nodes swellings around the stomach.  In fact, Figure 1a shows us a
small round mass near the stomach. Is this a lymph node or not. Anyway, more preoperative CT images
should be shown us. You mentioned like a mass in body of the pancreas with dilatation of the main
pancreatic duct, but you did not show us  the image of dilatation of the main pancreatic duct. I
recommend that figure 1 is used for preoperative CT images and that figure 2 is for postoperative
images.
(4) You mentioned that partial gastrectomy and lymphadenectomy were performed.  What kind of
partial gastrectomy did you perform?  What extend of lymphadenectomy did you perform? You should
describe operative procedure more precisely.
(5) The following sentence, "no recurrence was observed for 5 months", should be changed to "no
recurrence was observed for 5 months at the time of this writing"
(6) According to Matsui T, et al (World J Surg Oncol. 2019 Aug 5;17(1):134), 20 case reports are found
and the first case report is not Paquin but Hirooka.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
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 statistics 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.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years 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 in 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, funding, 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.
Nothing
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: Needle tract seeding recurrence of pancreatic cancer in the gastric wall with paragastric lymph
node metastasis after endoscopic ultrasound-guided fine needle aspiration followed by pancreatectomy:
a case report and literature review.
Version: 0 Date: 05 Dec 2019
Reviewer: Shuji Isaji
Reviewer's report:
This is very interesting case report in which needle tract seeding recurrence of pancreatic cancer in the
gastric wall with paragastric lymph node metastasis is described for the first time. The following
points, however, should be reconsidered.
(1) The authors only disribed operative procedure as distal pancreatectomy with lymphadenectomy.  In
this case report, operative findings are very important, stating the relationship between the stomach and
the tumor, and whether peritoneal dissemination or ascites is found nor not.  Additionally, distal
pancreatectomy is not appropriate. Distal pancreatosplenectomy or pancreatectomy with splenectomy
is preferred.  Is your procedure RAMPS anterior or posterior?
(2) It seems to me that the description of pathological findings is written according to Japanese
classification of pancreatic cancer (6th edition). Is this correct?  Histological findings should be also
provided , because you only show us the histology of the stomach tumor.
(3) In Figure 1a, only pancreatic tumor is shown; however, postoperatively paragastric lymph node
swelling developed as shown in Figure 1c. Therefore, preoperative CT images are additionally required
to show us that there are no lymph nodes swellings around the stomach.  In fact, Figure 1a shows us a
small round mass near the stomach. Is this a lymph node or not. Anyway, more preoperative CT images
should be shown us. You mentioned like a mass in body of the pancreas with dilatation of the main
pancreatic duct, but you did not show us  the image of dilatation of the main pancreatic duct. I
recommend that figure 1 is used for preoperative CT images and that figure 2 is for postoperative
images.
(4) You mentioned that partial gastrectomy and lymphadenectomy were performed.  What kind of
partial gastrectomy did you perform?  What extend of lymphadenectomy did you perform? You should
describe operative procedure more precisely.
(5) The following sentence, "no recurrence was observed for 5 months", should be changed to "no
recurrence was observed for 5 months at the time of this writing"
(6) According to Matsui T, et al (World J Surg Oncol. 2019 Aug 5;17(1):134), 20 case reports are found
and the first case report is not Paquin but Hirooka.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
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 statistics 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.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years 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 in 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, funding, 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.
Nothing
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: Needle tract seeding recurrence of pancreatic cancer in the gastric wall with paragastric lymph
node metastasis after endoscopic ultrasound-guided fine needle aspiration followed by pancreatectomy:
a case report and literature review.
Version: 0 Date: 05 Dec 2019
Reviewer: Shuji Isaji
Reviewer's report:
This is very interesting case report in which needle tract seeding recurrence of pancreatic cancer in the
gastric wall with paragastric lymph node metastasis is described for the first time. The following
points, however, should be reconsidered.
(1) The authors only disribed operative procedure as distal pancreatectomy with lymphadenectomy.  In
this case report, operative findings are very important, stating the relationship between the stomach and
the tumor, and whether peritoneal dissemination or ascites is found nor not.  Additionally, distal
pancreatectomy is not appropriate. Distal pancreatosplenectomy or pancreatectomy with splenectomy
is preferred.  Is your procedure RAMPS anterior or posterior?
(2) It seems to me that the description of pathological findings is written according to Japanese
classification of pancreatic cancer (6th edition). Is this correct?  Histological findings should be also
provided , because you only show us the histology of the stomach tumor.
(3) In Figure 1a, only pancreatic tumor is shown; however, postoperatively paragastric lymph node
swelling developed as shown in Figure 1c. Therefore, preoperative CT images are additionally required
to show us that there are no lymph nodes swellings around the stomach.  In fact, Figure 1a shows us a
small round mass near the stomach. Is this a lymph node or not. Anyway, more preoperative CT images
should be shown us. You mentioned like a mass in body of the pancreas with dilatation of the main
pancreatic duct, but you did not show us  the image of dilatation of the main pancreatic duct. I
recommend that figure 1 is used for preoperative CT images and that figure 2 is for postoperative
images.
(4) You mentioned that partial gastrectomy and lymphadenectomy were performed.  What kind of
partial gastrectomy did you perform?  What extend of lymphadenectomy did you perform? You should
describe operative procedure more precisely.
(5) The following sentence, "no recurrence was observed for 5 months", should be changed to "no
recurrence was observed for 5 months at the time of this writing"
(6) According to Matsui T, et al (World J Surg Oncol. 2019 Aug 5;17(1):134), 20 case reports are found
and the first case report is not Paquin but Hirooka.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
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 statistics 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.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years 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 in 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, funding, 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.
Nothing
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