Postoperative Complications Result in Poor Oncological Outcomes: What Is the Evidence?

Round 1

Reviewer 1 Report (Previous Reviewer 1)

Comments and Suggestions for Authors

Some minor points:

The terms “Coelomic Surgery” and 3.3.2. “Non-coelomic Surgeries” are used in the manuscript (see paragraphs 3.3.1., 3.4.2.1., 3.3.2., 3.4.2.2., 3.4.3., and pages 16 and 17). If you mean abdominal (intra-abdominal) operations then “abdominal” is more appropriate term.

Anastomotic leak (page 16). Use lower case.

Comments on the Quality of English Language

Some minor terminology as described in the comments to authors.

Author Response

Comment 1: The terms “Coelomic Surgery” and “Non-coelomic Surgeries” can be replaced with  “abdominal” etc

Reply 1: Thank you for your comment, The term ‘Coelomic’ is replaced with ‘thoracoabdominal’ and ‘non-coelomic’ is replaced with surface and soft tissue’

Comment 2: Anastomotic leak (page 16). Use lower case

Reply: The same has been accordingly. Thank You

Reviewer 2 Report (Previous Reviewer 3)

Comments and Suggestions for Authors

This review was reported the association between postoperative complications and oncological outcomes in several malignant neoplasms. The reviewer would like to suggest some critiques as follows.

 

1.     On page 1, line 4, what is “elective curative resection of tumors”?

2.     On page 1, line 16, what is “minor or major POC”?

3.     On page 2, line 1, what is “functional capacity”?

4.     On page 2, line 5, the reviewer thinks that “increased length of hospital stay” is correct.

5.     On page line 22, the authors should use major POC instead of major postoperative complications.

6.     On page 2, line 26, the reviewer could not understand “contributing to worsening outcomes”?

7.     Citation is required for mentions of Clavien-Dindo classification, CCI, and CTCAE. The authors should use CTCAE ver. 5.0.

8.     On page 14, line 11, is “lung resection” correct?

9.     On page 14, line 11, “from patients with no POC to those with” is better.

10.  If the name comes at the beginning of the sentence, the number of the cited reference should be given after it. i.e. Kube et al [23] found

11.  On page 15, line 19, “in patients with diabetes” is better. Please revise all such formal expressions.

12.  On page 16, line 11 what is “cancer outcomes”? Oncological outcomes?

13.  On page 16, line 4, “an Anatomical leak” is wrong.

14.  On page 16, line 5 and 13, a citation is required for this statement.

Comments on the Quality of English Language

Although the paper may have been checked by a native speaker, it is very difficult to read because of the abbreviations and grammatical errors.

Author Response

Comment 1: On page 1, line 4, what is “elective curative resection of tumors”?

Reply 1: Thank you for the comment, it is done as suggested. 

Comment 2: page 1, line 16, what is “minor or major POSTOPERATIVE COMPLICATIONS”?

Reply 2: Thank you for the comment, it is done as suggested. 

Comment 3: On page 2, line 1, what is “functional capacity”?

Reply 3: It is the "Functional capacity of patients following neo-adjuvant therapy"

Comment 4: On page 2, line 5, the reviewer thinks that “increased length of hospital stay” is correct.

Reply 4: Thank you for the comment, it is done as suggested. 

Comment 5: On page 2 line 22, the authors should use major POSTOPERATIVE COMPLICATIONS instead of major postoperative complications.

Reply 5: Thank you for the comment, it is done as suggested. 

Comment 6: On page 2, line 26, the reviewer could not understand “contributing to worsening outcomes”? 

Reply 6: Thank you for your comment, the sentence is modified.

Comment 7: Citation is required for mentions of Clavien-Dindo classification, CCI, and CTCAE. The authors should use CTCAE ver. 5.0.

Reply 7: Thank you for the comment, it is done as suggested. 

Comment 8: On page 14, line 11, is “lung resection” correct?

Reply 8: Yes, since the same term has been used in the title of the original article ref no 48.

Comment 9: On page 14, line 11, “from patients with no POSTOPERATIVE COMPLICATIONS to those with” is better.

Reply 9: Thank you for your comment, the sentence is modified.

Comment 10: If the name comes at the beginning of the sentence, the number of the cited reference should be given after it. i.e. Kube et al [23] found

Reply 10: Thank you for the comment, it is done throughout the manuscript as suggested. 

Comment 11: On page 15, line 19, “in patients with diabetes” is better. Please revise all such formal expressions.

Reply 11: Thank you for your comment, the sentence is modified.

Comment 12: On page 16, line 11 what is “cancer outcomes”? Oncological outcomes?

Reply 12: Thank you for your comment, the sentence is modified.

Comment 13: On page 16, line 4, “an Anatomical leak” is wrong.

Reply 13: Thank you for your comment, the sentence is modified.

Comment 14: On page 16, line 5 and 13, a citation is required for this statement.

Reply 14: Thank you for the comment, it is done as suggested. 

Comment 15: Although the paper may have been checked by a native speaker, it is very difficult to read because of the abbreviations and grammatical errors.

Reply 15: The uncommon abbreviations are removed and the English is corrected throughout the manuscript as suggested

 

Round 2

Reviewer 2 Report (Previous Reviewer 3)

Comments and Suggestions for Authors

none.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is a narrative review on the effects of complications occurring after curative resection of various adenocarcinomas on long-term survival, namely recurrence-free survival and overall survival.

The subject is very wide and with considerable heterogeneity regarding the primary tumor, type of operation, form of postoperative complications and their evaluation, and reported outcomes. These factors prevent a proper and scientifically sound data analysis and make it difficult to draw solid or valid conclusions. In fact the review presents the summaries of the included papers. This is a limitation not allowing clear and focused conclusions as seen in the conclusions section of the manuscript.

There are some minor linguistic errors within the manuscript that need attention.

Tables 2 and 3 were not included in the manuscript and were inaccessible in the supplementary files.

Comments on the Quality of English Language

There are some minor linguistic error.

Author Response

We very much appreciate the feedback from the reviewer. We revised the submission to make it more focused and concise. 

Please also note the change in the author lineup. 

Sincerely- Authors

Reviewer 2 Report

Comments and Suggestions for Authors

This study would review the outcome of post operative complications after surgery for tumors with curative intention on long term outcomes. 

The statements are known and the good point is that the authors made an overview of many tumors. 

Anyway, the authors should perform the analysis separating the different tumors. A pancreatic tumor cannot be in the same table & comments of bladder or neck tumor. 

-        

Author Response

We thank the reviewer for a very valid concern and comment. However, the literature is scant for us to derive any meaningful conclusion on a procedure basis. We felt we could coalesce the literature into two separate categories, coelomic and non-coelomic. While very general in that categorization, we felt this could still provide some direction to focus our efforts on minimizing specific complications that could contribute to poor oncological outcomes. 

Reviewer 3 Report

Comments and Suggestions for Authors

This study was reported the association between postoperative complications and oncological outcomes in several malignant neoplasms. The reviewer would like to suggest some critiques as follows.

 

1.     Overall, it is very difficult to understand this paper. Because it is a review of various types of cancers. It needs to be reconstructed by examining the target cancers by site.

2.     On line 17, what is POCs? Do the authors prefer to use POCs or postoperative complications? The two terms are mixed in the text.

3.     On line 28, what is procedure-specific risk factors? The authors describe the types of complications and oncological outcomes; however, is it correct to assume that this is common to all malignancies?

4.     On line 46, what is abdominal multi-visceral resection?

5.     On line 59, what is complications? Pre? Post?

6.     Tables is difficult to understand. The authors should structure the tables so that readers can easily understand them.

7.     On line 177, what is neo-adjuvant therapies? Neoadjuvant chemotherapies?

The method of describing the reference is different from the submission rules.

Author Response

We thank the reviewer for their concerns and constructive feedback.

Below is a point-by-point response to the questions/comments:

1. We revised the submission to make it more focused and concise. We further narrowed the description down to two broad categories of surgical procedures- coelomic and non-coelomic. We believe this will help focus our attention on areas where we can minimize procedure-specific complications and help improve oncological outcomes.
2. We referred to POC consistently in the document. Thank you for the suggestion.
3. Cancer surgery encompasses a wide variety of procedures with procedure-specific complications (for example, pancreatic fistula and leaks for Whipple, compared to atrial fibrillation for thoracic procedures); the risk factors for each of these complications vary by the procedure. However, since risk prediction is beyond the scope of this submission, we did not address those factors.
4. We're sorry but don't see an "abdominal multi-visceral resection" reference in line 46 in the original submitted version. Apologies if there is a mix-up in the submission. However, it is known that multi-visceral resection (multiple organs being resected with larger areas of denuded surfaces and potentially multiple anastomoses) leads to a more significant number of complications and increased hospital length of stay.
5. We are sorry but we don't see a reference to pre and post-complications in the version we submitted on line 59.
6. Thank you. Agree. Corrected. 
7. Thank you for pointing that out. Corrected.