Review for 10.1186/s12876-025-03724-2 (2025)

Title: Comparison of short-term efficacy of laparoscopic proximal gastrectomy with modified
side overlap anastomosis and laparoscopic total gastrectomy with Roux-en-Y anastomosis
Version: 2 Date: 26 Jan 2025
Reviewer's report:
Thank you for your valuable article, and it is my pleasure to review the manuscript entitled
“Comparison of short-term efficacy of laparoscopic proximal gastrectomy with modified side
overlap anastomosis and laparoscopic total gastrectomy with Roux-en-Y anastomosis”. The
authors stated, in this retrospective study, that LPG with a modified side overlap anastomosis
is safe, and compared with traditional LTG, its postoperative nutritional status is better. This
paper gives us the important information, however it has also a number of weaknesses. Thus, I
would provide the following comments and queries.
Major comment #1) The authors stated that LPG using the overlap method provides better
nutritional status than LTG with RY. I totally agree with this conclusion. However, as the
authors described in the surgical method, the LPG with overlap method was performed as a
“Laparoscopy-assisted” method in which upper abdominal incision was performed from the
xyphoid. Totally laparoscopic TG has been reported to provide better quality of life (STO
22 eating) compared to Laparoscopy-assisted TG. Likewise, the totally laparoscopic PG with
overlap method is thought to provide a better eating-related quality of life and possibly provide
a better nutritional status than the laparoscopic-assisted PG with overlap method. Cite the
literature below and describe related issues in the limitation part of the discussion in addition
to the section that described the limitation of the small number of patients operated on with the
LPG with overlap method.
Reference) Park SH, Suh YS, Kim TH, Choi YH, Choi JH, Kong SH, Park DJ, Lee HJ, Yang
HK. Postoperative morbidity and quality of life between totally laparoscopic total gastrectomy
and laparoscopy-assisted total gastrectomy: a propensity-score matched analysis. BMC Cancer.
2021 Sep 11;21(1):1016. doi: 10.1186/s12885-021-08744-1.
Minor comment #1) The authors should modify some words like as follows.
In page 2, line 6:
Before revision: The clinicopathological data of 262 patients who underwent LPG for upper
gastric adenocarcinoma from January 2016 to December 2022 were collected. Among 262
patients, 20 patients who underwent LPG with a modified side overlap anastomosis were
assigned to the side overlap group and the 242 who underwent LTG with Roux-en-Y anastomosis
were assigned to the Roux-en-Y group.
After revision: The clinicopathological data of 262 patients who underwent surgery for upper
gastric adenocarcinoma from January 2016 to December 2022 were collected. Among 262
patients, 20 patients who underwent LPG with a modified side overlap anastomosis were
assigned to the side overlap group and the 242 who underwent LTG with Roux-en-Y anastomosis
were assigned to the Roux-en-Y group.
Minor comment #2) Figure 2 to 6 describes how to make the overlap method. Since, this paper
has too many figures, please make Figure 2, 3, 4, 5, 6 to Figure 2a, 2b, 2c, 2d, 2e.