Review for 10.1186/s12876-015-0411-2 (2015)

Reviewer's report
Title:LDP vs ODP for pancreatic adenocarcinoma: A case matched study from a
single-institution
Version:3Date:17 September 2015
Reviewer: Marilisa Citton
Reviewer's report:
This is a study aimed to analyze the outcomes of laparoscopic distal
pancreatectomy for pancreatic adenocarcinoma, compared with open approach.
It’s a case-matched retrospective study including 45 patients. It’s an interesting
work, for the limited data in literature, but I have the following criticisms.
1-More informations about the design of the study and patient selection are
required. Why did you choose this type of study?
Concerning exclusion criteria for LDP, how many patients were excluded on the
basis of these criteria? You report that 17 LDPs were performed including 2
conversion that were excluded, so finally 15 LDP cases were enroled in the
study. After in the discussion you write “we excluded patients who underwent
LDP, with tumor size >5 cm in body and >10 cm in tail of the pancreas”.
There were exclusion/inclusion criteria for ODP? What about ODP not included in
the study (21 cases)?
2- Method: the “operative technique” section is too long and detailed and it can
be lightened. Conversely in the section “definition of outcomes”, a brief
description of Clavien-Dindo classification and of the grading of postoperative
pancreatic fistula would be appropriate. In the “patients follow-up” section, “All
patients were regularly followed up” is too vague; please be more precise.
3- Result: in the fourth sentence of “Comparison of surgical outcome for PDAC”
there is an error. You report “the first flatus time and diet start time were shorter
in LDP group 2.67+0.8d vs 3.8+0.1d, P=0.000...) while first oral intake showed no
significant differences between the two groups (p=0.183)”.
In “survival” section more result about adjuvant treatment are needed: you can
move it there from the last part of the discussion.
4-Tables and figures: tables are not self-explaining. Please add log rank test
p-value in figures.
MINOR ISSUES NOT FOR PUBBLICATION:
Abstract (background)
Pancreatic ductal adenocarcinoma: you used both “PDCA” or “PDAC” as
abbreviation.
Abstract (method)
“30 patients were underwent”: probably it is “30 patients who underwent”.
Abstract (results)
Concerning first flatus values “2.67+0.816d vs 3.83+0.950d, P=0.000”: change
“+” with “±” and add p value.
Key words
Please add “surgery” or “access” after the key word “open”.
Introduction
- Remove the point between “oncologic safety” and the reference 4.
- I think that you had to report the extent form of the abbreviations (LDP, ODP
and PDAC), and correct “PDCA” with “PDAC” in the last phrase.
Method
Patient sample and data collection
- Please report in this section the extent form of ASA and BMI.
- The last part of this paragraph (the description of collected data) is a bit
confused: i.e you wrote “…postoperative complications, the postoperative
pancreatic fistulae….”, but the fistula is itself a complication; furthermore you can
put “tumor size” near “tumor grade, tumor stage…” and change “R0 resection”
with “ resection margin status”.
Results
Baseline characteristic
-You had to remove from this section the extent form of ASA and BMI and add
the extent form of “DM”.
Comparision of surgical outcomes for PDAC
- In the second paragraph of the section, please add “resection” between “partial”
and “portal vein”.
- In the last sentence of this section you can change “one mortality” with “one
death”.
Comparision of Clinicopathologic Characteristic
I think that you can use lowercase letters for “Clinicopathologic Characteristic” in
the title and in the first phrase of the paragraph.
Survival
In the first phrase move “for ODP group” before “21.7 months and 14.0 months”.
Discussion
Please add the extent form of “SMA” in the middle of this section
Tables
Table 2: p-value of first flatus time is wrong.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.