In Reply We appreciate the interest in our article and thank JAMA Surgery for the opportunity to reply to the letters to the editor.1 Shi et al advised that combining patients without postoperative pancreatic fistula (POPF) and with biochemical leakage may have biased the analysis regarding long-term survival in patients receiving neoadjuvant therapy (NAT). While biochemical leakage may reflect a more preserved gland function, which has been associated with better survival in upfront resected pancreatic cancer,2 a preliminary analysis had shown no significant differences between biochemical leakage and no pancreatic fistula in patients with NAT.
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Hank T, Sandini M, Fernández-del Castillo C. Prognostic Value of Pancreatic Fistula in Resected Patients With Pancreatic Cancer With Neoadjuvant Therapy—Reply. JAMA Surg. 2020;155(3):269. doi:10.1001/jamasurg.2019.5091
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