- Email: [email protected]
Addressing Study Limitations
LETTERS
Intraductal Papillary Mucinous Neoplasms
We would like to thank the authors of this letter for their interest in our recently published manuscript evaluating the value of the Fukuoka Guidelines in the risk stratification of intraductal papillary mucinous neoplasms (IPMN) of the pancreas. The ideal management of IPMNs with low-risk features continues to be an area of active discussion and research. In our retrospective analysis, we reported on 324 patients with surgical resected IPMNs from 7 academic institutions, over a 15-year period. As highlighted by Drs Goh and Srinivasan, 1 limitation of this study is that there were data that were missing, not reported, or simply unavailable. This is the reason that the type of cyst data regarding main-duct, mixed, or branch-duct IPMN does not add up to 324. Regarding tumor grade, there were no missing data, but rather, the remainder of patients had no dysplasia reported in the pathologic specimen. In our analysis of patients with “no highrisk features” (Table 5), we evaluated for risk factors associated with high-grade dysplasia/invasive carcinoma in this subset of patients. In order to keep this analysis as rigorous as possible, we did eliminate any patient with missing or absent Fukuoka criteria data. This accounts for the discrepancy in patient numbers that Drs Goh and Srinivasan refer to. We would again like to thank the authors for their interest in the article and we hope that this clarifies the questions they have raised.
Brian KP Goh, MBBS, MMed, MSc, FRCSEd, Nandhini Srinivasan Singapore We read with interest the recent article by Wilson and colleagues,1 which evaluated the value of the Fukuoka Guidelines in stratifying intraductal papillary mucinous neoplasms (IPMN) in 324 patients from 7 institutions. We would like to highlight several calculation errors in their study, especially with regard to the pathologic data. In Table 3, they reported 95 main-duct IPMN, 51 mixed type, and 96 branch-duct type, which only tallied up to 242 cases. Also in Table 3, they reported 136 malignant, 64 intermediate-grade, and 77 low-grade IPMN, which tallied only to 277 cases. Could the authors explain what happened to the “missing pathological data”? Similarly, in Table 5, the authors reported 42 malignant among 61 high-risk IPMN, 64 malignant among 160 worrisomerisk, and 14 malignant among 57 low-risk IPMN. The total number of cases was only 278 (61 þ 160 þ 57) and the total number of malignant IPMN was 120 (42 þ 64 þ 14). This is not consistent with the results in their abstract or manuscript, which reported that 136 (not 120) of the 324 IPMN were malignant. Based on our interpretation of their data, we suspect that there should be 80 malignant among 206 worrisome-risk IPMN. We hope the authors can clarify and correct these errors in their manuscript.
Disclosure Information: Nothing to disclose.
REFERENCE
A Remodeled Gastric Stump Facilitates Digestive Reconstruction after Pancreaticoduodenectomy
1. Wilson GC, Maithel SK, Bentrem D, et al. Are the current guidelines for the surgical management of intraductal papillary mucinous neoplasms of the pancreas adequate? A multiinstitutional study. J Am Coll Surg 2017;224:461e469.
Disclosure Information: Nothing to disclose.
Antonio Manenti, PhD, Gabriele Melegari, MD, PhD, Gianrocco Manco, MD, Maurizio Zizzo, Alberto Farinetti, MD, PhD Modena, Italy
Addressing Study Limitations In Reply to Goh and Srinivasan Gregory C Wilson, MD, Syed A Ahmad, MD, FACS Cincinnati, OH ª 2017 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.
MD,
We read with interest the article by Khan and colleagues1 concerning the reduction of delayed gastric emptying by a “flange” gastroenterostomy after pancreaticoduodenectomy.
682
http://dx.doi.org/10.1016/j.jamcollsurg.2017.08.002 ISSN 1072-7515/17
Intraductal Papillary Mucinous Neoplasms
We would like to thank the authors of this letter for their interest in our recently published manuscript evaluating the value of the Fukuoka Guidelines in the risk stratification of intraductal papillary mucinous neoplasms (IPMN) of the pancreas. The ideal management of IPMNs with low-risk features continues to be an area of active discussion and research. In our retrospective analysis, we reported on 324 patients with surgical resected IPMNs from 7 academic institutions, over a 15-year period. As highlighted by Drs Goh and Srinivasan, 1 limitation of this study is that there were data that were missing, not reported, or simply unavailable. This is the reason that the type of cyst data regarding main-duct, mixed, or branch-duct IPMN does not add up to 324. Regarding tumor grade, there were no missing data, but rather, the remainder of patients had no dysplasia reported in the pathologic specimen. In our analysis of patients with “no highrisk features” (Table 5), we evaluated for risk factors associated with high-grade dysplasia/invasive carcinoma in this subset of patients. In order to keep this analysis as rigorous as possible, we did eliminate any patient with missing or absent Fukuoka criteria data. This accounts for the discrepancy in patient numbers that Drs Goh and Srinivasan refer to. We would again like to thank the authors for their interest in the article and we hope that this clarifies the questions they have raised.
Brian KP Goh, MBBS, MMed, MSc, FRCSEd, Nandhini Srinivasan Singapore We read with interest the recent article by Wilson and colleagues,1 which evaluated the value of the Fukuoka Guidelines in stratifying intraductal papillary mucinous neoplasms (IPMN) in 324 patients from 7 institutions. We would like to highlight several calculation errors in their study, especially with regard to the pathologic data. In Table 3, they reported 95 main-duct IPMN, 51 mixed type, and 96 branch-duct type, which only tallied up to 242 cases. Also in Table 3, they reported 136 malignant, 64 intermediate-grade, and 77 low-grade IPMN, which tallied only to 277 cases. Could the authors explain what happened to the “missing pathological data”? Similarly, in Table 5, the authors reported 42 malignant among 61 high-risk IPMN, 64 malignant among 160 worrisomerisk, and 14 malignant among 57 low-risk IPMN. The total number of cases was only 278 (61 þ 160 þ 57) and the total number of malignant IPMN was 120 (42 þ 64 þ 14). This is not consistent with the results in their abstract or manuscript, which reported that 136 (not 120) of the 324 IPMN were malignant. Based on our interpretation of their data, we suspect that there should be 80 malignant among 206 worrisome-risk IPMN. We hope the authors can clarify and correct these errors in their manuscript.
Disclosure Information: Nothing to disclose.
REFERENCE
A Remodeled Gastric Stump Facilitates Digestive Reconstruction after Pancreaticoduodenectomy
1. Wilson GC, Maithel SK, Bentrem D, et al. Are the current guidelines for the surgical management of intraductal papillary mucinous neoplasms of the pancreas adequate? A multiinstitutional study. J Am Coll Surg 2017;224:461e469.
Disclosure Information: Nothing to disclose.
Antonio Manenti, PhD, Gabriele Melegari, MD, PhD, Gianrocco Manco, MD, Maurizio Zizzo, Alberto Farinetti, MD, PhD Modena, Italy
Addressing Study Limitations In Reply to Goh and Srinivasan Gregory C Wilson, MD, Syed A Ahmad, MD, FACS Cincinnati, OH ª 2017 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.
MD,
We read with interest the article by Khan and colleagues1 concerning the reduction of delayed gastric emptying by a “flange” gastroenterostomy after pancreaticoduodenectomy.
682
http://dx.doi.org/10.1016/j.jamcollsurg.2017.08.002 ISSN 1072-7515/17