Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 3 Date: 26 May 2024
Reviewer's report:
Thank you for this informative study, I have a few cooments below
1. in the 4 years (January 2019 to December 2022), were there any resectable cases of pancreatic
cancer, or all cases were unresectable and thus underwent palliative by pass surgery only.
2.  was pancreatic cancer unresectability determined pre-operatively by imaging studies, intra-
operatively by the surgeons's findings or both?
3. MD Anderson, AHPBA/SSAT/SSO, NCCN etc have well defined criteria of pancreatic cancer
resectability based on major vascular involvement (celiac axis, CHA, SMA, SMV/PV). Which
criteria was used and were pre-operative findings correlating with intra-operative findings.
4. I note that your data collection tool had  ( resident, surgeon, hepatobiliary surgeon).  Was
a hepatobiliary surgeon or surgical oncologist involved in any of this surgeries? is it possible
that some cases that might have been classified as unresectable by resident could have been
resectable under hepatobilairy surgeon with skills to do vascular reconstruction especially portal
vein reconstruction?
5. you have clearly quoted previous studies from Tanzania (Kivuyo et al) and Nigeria, how
does your data compare with other Hepatopancreatobiliary surgery studies within East Africa
(Kenya, Uganda, Rwanda etc)?
6. it's striking that 6 patients were re-admitted and all the 6 re-admitted patients all died? any
explanation? and contributed to the high total 30-day mortality.
8. For purposes of clarity can surgeon classification be clear like it is in the data collection
tool, does surgeon in this case mean general surgeon, ( use clear qualifications; resident, general
surgeon, hepatobiliary surgeon, surgical oncologist etc)
9. Any availability of interventional radiologist with capacity to do percutaneous transhepatic
biliary drainage or availability of interventional endoscopy services like ERCP, EUS in this
center or nearby centres?
10. 34 patients did not meet the inclusion criteria, this number appears big, kindly elucidate
which parts of the inclusion criteria they did not meet.
Title: PALLIATIVE BILIODIGESTIVE BYPASS FOR UNRESECTABLE PANCREATIC
MALIGNANCY AT KILIMANJARO CHRISTIAN MEDICAL CENTRE: A
RETROSPECTIVE CROSS-SECTIONAL STUDY
Version: 3 Date: 26 May 2024
Reviewer's report:
Thank you for this informative study, I have a few cooments below
1. in the 4 years (January 2019 to December 2022), were there any resectable cases of pancreatic
cancer, or all cases were unresectable and thus underwent palliative by pass surgery only.
2.  was pancreatic cancer unresectability determined pre-operatively by imaging studies, intra-
operatively by the surgeons's findings or both?
3. MD Anderson, AHPBA/SSAT/SSO, NCCN etc have well defined criteria of pancreatic cancer
resectability based on major vascular involvement (celiac axis, CHA, SMA, SMV/PV). Which
criteria was used and were pre-operative findings correlating with intra-operative findings.
4. I note that your data collection tool had  ( resident, surgeon, hepatobiliary surgeon).  Was
a hepatobiliary surgeon or surgical oncologist involved in any of this surgeries? is it possible
that some cases that might have been classified as unresectable by resident could have been
resectable under hepatobilairy surgeon with skills to do vascular reconstruction especially portal
vein reconstruction?
5. you have clearly quoted previous studies from Tanzania (Kivuyo et al) and Nigeria, how
does your data compare with other Hepatopancreatobiliary surgery studies within East Africa
(Kenya, Uganda, Rwanda etc)?
6. it's striking that 6 patients were re-admitted and all the 6 re-admitted patients all died? any
explanation? and contributed to the high total 30-day mortality.
8. For purposes of clarity can surgeon classification be clear like it is in the data collection
tool, does surgeon in this case mean general surgeon, ( use clear qualifications; resident, general
surgeon, hepatobiliary surgeon, surgical oncologist etc)
9. Any availability of interventional radiologist with capacity to do percutaneous transhepatic
biliary drainage or availability of interventional endoscopy services like ERCP, EUS in this
center or nearby centres?
10. 34 patients did not meet the inclusion criteria, this number appears big, kindly elucidate
which parts of the inclusion criteria they did not meet.
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: 26 May 2024
Reviewer's report:
Thank you for this informative study, I have a few cooments below
1. in the 4 years (January 2019 to December 2022), were there any resectable cases of pancreatic
cancer, or all cases were unresectable and thus underwent palliative by pass surgery only.
2.  was pancreatic cancer unresectability determined pre-operatively by imaging studies, intra-
operatively by the surgeons's findings or both?
3. MD Anderson, AHPBA/SSAT/SSO, NCCN etc have well defined criteria of pancreatic cancer
resectability based on major vascular involvement (celiac axis, CHA, SMA, SMV/PV). Which
criteria was used and were pre-operative findings correlating with intra-operative findings.
4. I note that your data collection tool had  ( resident, surgeon, hepatobiliary surgeon).  Was
a hepatobiliary surgeon or surgical oncologist involved in any of this surgeries? is it possible
that some cases that might have been classified as unresectable by resident could have been
resectable under hepatobilairy surgeon with skills to do vascular reconstruction especially portal
vein reconstruction?
5. you have clearly quoted previous studies from Tanzania (Kivuyo et al) and Nigeria, how
does your data compare with other Hepatopancreatobiliary surgery studies within East Africa
(Kenya, Uganda, Rwanda etc)?
6. it's striking that 6 patients were re-admitted and all the 6 re-admitted patients all died? any
explanation? and contributed to the high total 30-day mortality.
8. For purposes of clarity can surgeon classification be clear like it is in the data collection
tool, does surgeon in this case mean general surgeon, ( use clear qualifications; resident, general
surgeon, hepatobiliary surgeon, surgical oncologist etc)
9. Any availability of interventional radiologist with capacity to do percutaneous transhepatic
biliary drainage or availability of interventional endoscopy services like ERCP, EUS in this
center or nearby centres?
10. 34 patients did not meet the inclusion criteria, this number appears big, kindly elucidate
which parts of the inclusion criteria they did not meet.
assistant