Review for 10.1186/s12876-025-03868-1 (2025)

Title: Emergency Pancreatoduodenectomy for Non-Traumatic Conditions: A Case Series
Analysis
Version: 3 Date: 05 Mar 2025
Reviewer's report:
Thank you for submitting this manuscript.
Please go through the manuscript step by step, revise the manuscript, and check the language
and grammar mistakes; also, Improves readability and grammatical structure.
The phrase “and a literature review was also conducted” feels like an afterthought.
Suggestion: “A retrospective analysis was conducted on patients who underwent non-traumatic
EPD at the 900th Hospital of the Joint Logistics Support Force of the Chinese People’s
Liberation Army (PLA) from January 2013 to September 2023. The study assessed preoperative
etiologies, intraoperative findings, postoperative complications, and prognosis. Additionally, a
literature review was performed.”
You use both “pancreaticoduodenal region” and “pancreatic head and duodenal region.” For
consistency, choose one term and use it throughout the abstract.
The phrase “resulting in an 85.7% incidence rate” is redundant since incidence rates are usually
stated directly.
Suggestion:“Postoperative complications occurred in six patients (85.7%), including pancreatic
fistula, ………...
Introduction
“This poses a significant challenge…” is repetitive.
The phrase “emergency resuscitation measures” and “emergency rescue measures” seem
redundant.
Suggestion: “Serious complications such as hypovolemia, hypothermia, and coagulation
disorders present major challenges to emergency resuscitation efforts.”
Objective: Shortens the sentence while keeping the meaning intact.
Suggestion: “This study retrospectively analyzed non-traumatic EPD cases at our institution to
guide clinical management and improve patient survival.”
Methods:
Not all emergency surgeries must occur within 24 hours of admission. Some cases may require
initial stabilization before emergency intervention. If your study truly limits cases to 24-hour
admission-to-surgery, this should be clarified as a strict criterion.
Original: “(3) the surgical approach was standard PD or modified procedures.”
“Modified procedures” is vague. PD variations include pylorus-preserving
pancreaticoduodenectomy (PPPD), vascular resection and reconstruction, and subtotal stomach-
preserving PD. If your study included specific variations, they should be explicitly stated.
Results
The term “enormous mass” is non-specific and not standard medical terminology
While the classification of pancreatic fistula as “Grade B” is appropriate per the ISGPS
(International Study Group of Pancreatic Surgery) criteria, biliary fistula and other
complications should ideally follow standardized classifications as well.
Clarify whether biliary fistula was graded according to the ISGLS (International Study Group
of Liver Surgery) classification and specify if other complications (e.g., abdominal infection)
were classified by recognized criteria.
Since the sample size is small (9 cases), stating mortality as a percentage may be misleading
without context. This rate should be interpreted cautiously given the small sample size.
Discussion
Many statements, particularly about incidence rates, outcomes, and management strategies,
should be supported by recent studies and systematic reviews.
Cite specific studies or systematic reviews that report the most updated mortality rates.
Pancreatitis can cause duodenal ischemia due to inflammation and vascular thrombosis,
but duodenal necrosis is relatively rare compared to pancreatic necrosis. The claim should
acknowledge that while pancreatitis can contribute to duodenal damage, direct duodenal necrosis
is uncommon.
Conclusion
“but the indications for surgery need to be strictly grasped.” The phrase “strictly grasped” is
not a typical medical term and sounds somewhat informal. A more appropriate term would be
“carefully considered” or “clearly defined.”
References
Consider checking the reference style guide (e.g., APA, AMA, Vancouver, etc.) for specific
instructions on formatting.
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