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's report:
This systematic review and meta-analysis included a total of 10 RCTs with 574 patients
underwent pancreaticoduodenectomy found that perioperative immunonutrition can reduce
postoperative infection-related complications
A literature review using the keywords “pancreaticoduodenectomy” and “immunonutrition”
revealed three systematic review and meta-analysis in the past three years. Can the authors justify
the need for a new systematic review and meta-analysis and include it in the discussion section?
https://pubmed.ncbi.nlm.nih.gov/37069556/
https://pubmed.ncbi.nlm.nih.gov/32613544/
https://pubmed.ncbi.nlm.nih.gov/34836308/
In the literature retrieval strategy subsection, materials and methods section, the elaboration of
the search strategy is insufficient. The authors will need to publish the search strategy used in
the individual database.
Under the statistical analysis subsection, materials and methods section, the selection of a
computational model should be done a priori depending on whether all studies share a true effect
size. The authors adopted the wrong practice of starting with a fixed-effect model and then
switching to a random-effects model if the test of homogeneity is statistically significant.
Under the statistical analysis subsection, materials and methods section,  the authors stated
“When more than five studies were included, a funnel plot was used to assess potential
publication bias. P < 0.05 is considered to indicate a significant overall effect.”. How did the
authors arrive at five studies? Is there any evidence to support this practice?
Kindly revise Figure 1. The records excluded and reasons to exclude full articles should be one
level higher.
Under discussion section, the authors used “by performing a more exhaustive literature search”.
This statement is relative to which study? The existing systematic review and meta-analysis
in the literature already included all the RCTs in this present study which reached the similar
conclusions.
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's report:
This systematic review and meta-analysis included a total of 10 RCTs with 574 patients
underwent pancreaticoduodenectomy found that perioperative immunonutrition can reduce
postoperative infection-related complications
A literature review using the keywords “pancreaticoduodenectomy” and “immunonutrition”
revealed three systematic review and meta-analysis in the past three years. Can the authors justify
the need for a new systematic review and meta-analysis and include it in the discussion section?
https://pubmed.ncbi.nlm.nih.gov/37069556/
https://pubmed.ncbi.nlm.nih.gov/32613544/
https://pubmed.ncbi.nlm.nih.gov/34836308/
In the literature retrieval strategy subsection, materials and methods section, the elaboration of
the search strategy is insufficient. The authors will need to publish the search strategy used in
the individual database.
Under the statistical analysis subsection, materials and methods section, the selection of a
computational model should be done a priori depending on whether all studies share a true effect
size. The authors adopted the wrong practice of starting with a fixed-effect model and then
switching to a random-effects model if the test of homogeneity is statistically significant.
Under the statistical analysis subsection, materials and methods section,  the authors stated
“When more than five studies were included, a funnel plot was used to assess potential
publication bias. P < 0.05 is considered to indicate a significant overall effect.”. How did the
authors arrive at five studies? Is there any evidence to support this practice?
Kindly revise Figure 1. The records excluded and reasons to exclude full articles should be one
level higher.
Under discussion section, the authors used “by performing a more exhaustive literature search”.
This statement is relative to which study? The existing systematic review and meta-analysis
in the literature already included all the RCTs in this present study which reached the similar
conclusions.
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's report:
This systematic review and meta-analysis included a total of 10 RCTs with 574 patients
underwent pancreaticoduodenectomy found that perioperative immunonutrition can reduce
postoperative infection-related complications
A literature review using the keywords “pancreaticoduodenectomy” and “immunonutrition”
revealed three systematic review and meta-analysis in the past three years. Can the authors justify
the need for a new systematic review and meta-analysis and include it in the discussion section?
https://pubmed.ncbi.nlm.nih.gov/37069556/
https://pubmed.ncbi.nlm.nih.gov/32613544/
https://pubmed.ncbi.nlm.nih.gov/34836308/
In the literature retrieval strategy subsection, materials and methods section, the elaboration of
the search strategy is insufficient. The authors will need to publish the search strategy used in
the individual database.
Under the statistical analysis subsection, materials and methods section, the selection of a
computational model should be done a priori depending on whether all studies share a true effect
size. The authors adopted the wrong practice of starting with a fixed-effect model and then
switching to a random-effects model if the test of homogeneity is statistically significant.
Under the statistical analysis subsection, materials and methods section,  the authors stated
“When more than five studies were included, a funnel plot was used to assess potential
publication bias. P < 0.05 is considered to indicate a significant overall effect.”. How did the
authors arrive at five studies? Is there any evidence to support this practice?
Kindly revise Figure 1. The records excluded and reasons to exclude full articles should be one
level higher.
Under discussion section, the authors used “by performing a more exhaustive literature search”.
This statement is relative to which study? The existing systematic review and meta-analysis
in the literature already included all the RCTs in this present study which reached the similar
conclusions.
assistant