Title: Impact of perioperative immunonutrition on postoperative outcomes in
pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled
trials.
Version: 2 Date: 15 Oct 2024
Reviewer:  Monish Karunakaran
Reviewer's report:
I really enjoyed reading the manuscript and would like to offer the following comments.
1. While introducing the premise of the study, I would urge the authors to state the important role
played by the ERAS protocols in improving the post-operative recovery of patients undergoing
pancreatoduodenectomy in the Introduction section.
2. In a meta-analysis by Probst et al (PMID: 28940219), immuno-nutrition was associated with
reduced overall and infectious complications in 83 RCTs with 7116 patients (grade of evidence
low to moderate). Not only these effects vanish after excluding trials at high risk of bias,
alarmingly, non-industry-funded trials did not display positive effects for overall complications,
whereas industry-funded reported large effects.
Did the authors notice similar trend in the current study? If not already done, is it possible to do
a segregated analysis within the current meta-analysis in pancreatoduodenectomy?
Title: Impact of perioperative immunonutrition on postoperative outcomes in
pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled
trials.
Version: 2 Date: 15 Oct 2024
Reviewer:  Monish Karunakaran
Reviewer's report:
I really enjoyed reading the manuscript and would like to offer the following comments.
1. While introducing the premise of the study, I would urge the authors to state the important role
played by the ERAS protocols in improving the post-operative recovery of patients undergoing
pancreatoduodenectomy in the Introduction section.
2. In a meta-analysis by Probst et al (PMID: 28940219), immuno-nutrition was associated with
reduced overall and infectious complications in 83 RCTs with 7116 patients (grade of evidence
low to moderate). Not only these effects vanish after excluding trials at high risk of bias,
alarmingly, non-industry-funded trials did not display positive effects for overall complications,
whereas industry-funded reported large effects.
Did the authors notice similar trend in the current study? If not already done, is it possible to do
a segregated analysis within the current meta-analysis in pancreatoduodenectomy?
Please review this paper.
user
Title: Impact of perioperative immunonutrition on postoperative outcomes in
pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled
trials.
Version: 2 Date: 15 Oct 2024
Reviewer:  Monish Karunakaran
Reviewer's report:
I really enjoyed reading the manuscript and would like to offer the following comments.
1. While introducing the premise of the study, I would urge the authors to state the important role
played by the ERAS protocols in improving the post-operative recovery of patients undergoing
pancreatoduodenectomy in the Introduction section.
2. In a meta-analysis by Probst et al (PMID: 28940219), immuno-nutrition was associated with
reduced overall and infectious complications in 83 RCTs with 7116 patients (grade of evidence
low to moderate). Not only these effects vanish after excluding trials at high risk of bias,
alarmingly, non-industry-funded trials did not display positive effects for overall complications,
whereas industry-funded reported large effects.
Did the authors notice similar trend in the current study? If not already done, is it possible to do
a segregated analysis within the current meta-analysis in pancreatoduodenectomy?
assistant