Comment on “Implications of Perineural Invasion on Disease Recurrence and Survival After Pancreatectomy for Pancreatic Head Ductal Adenocarcinoma by Crippa et al.”

Abstract

R esponse to RESPONSE TO LET-TER, We welcome the comments from Moris et al in relation to our recently published study, the Conservative versus operative ManageMent of acute uncomplicated Appendicitis (COMMA) trial. 1 We agree that the EQ-5D-5L quality of life instrument may be more sensitive than the EQ-5D-3L. However, the COMMA trial commenced recruitment in 2016 when the EQ-5D-5L instrument lacked validation and a local value set. Thus, the EQ-5D-3L instrument was utilized.We do not agree with the comment that a decision to treat with surgery was at the discretion of the operating surgeon. patients were randomized in the COMMA trial to antibiotics only or surgery in accordance with a predefined randomization process which had no input from the treating surgeon. Through this randomization process we identified a 25% failure rate associated with antibiotics only at one year which is remarkably consistent with previously published trials. There should be no longer any doubt around the remarkably high failure rates associated with an antibiotics only treatment strategy and on this basis, surgery should be offered routinely to patients with acute appendicitis.Yours sincerely,

Unraveling the Connection: Pancreatic Cancer Cells and Schwann Cells

“…In a retrospective assessment by Crippa et al involving 778 patients with PDAC who had undergone surgical intervention between 2009 and 2014, it was revealed that NI was detected in 87% of cases. Importantly, NI emerged as an independent risk factor significantly influencing disease-free survival (DFS) and overall survival (OS) ( p < 0.0001), establishing its potential role as a prognostic indicator [ 5 , 6 ].…”