Review for 10.1186/s12876-025-03848-5 (2025)

Title: Comparing surgical and conservative treatment approaches for perianal abscess in patients
with hematologic malignancies: a comprehensive analysis
Version: 4 Date: 02 Mar 2025
Reviewer:  Mohamed H. Zidan
Reviewer's report:
Dear Authors,
Re: Comparing Surgical and Conservative Treatment Approaches for Perianal Abscess in
Patients with Hematologic Malignancies: A Comprehensive Analysis
Your manuscript presents a valuable and clinically relevant analysis of the management of
perianal abscess in patients with hematologic malignancies. The study provides a meaningful
comparison between surgical and conservative treatment approaches, and the findings contribute
to the existing knowledge regarding the optimal management strategies for these patients. The
inclusion of a 60-day follow-up and the assessment of multiple clinical parameters strengthen the
reliability of the results. Furthermore, the discussion on the challenges associated with surgical
intervention in immunocompromised patients is well-articulated and aligns with current clinical
concerns.
Despite these strengths, several areas require further refinement to improve the clarity and
impact of your manuscript. The methodology section requires more detailed information
regarding the eligibility criteria for patient selection. The definition of perianal abscess is well-
established in your study, but a more explicit explanation of how cases were included or excluded
would improve the transparency of the study design.
Additionally, The manuscript provides a general description of the surgical interventions but
lacks detailed operative details. The manuscript mentions that patients in the surgical group
underwent either abscess incision and drainage (16 cases, 84.2%) or abscess incision with thread
drawing (3 cases, 15.8%). However, there is no detailed description of the surgical techniques,
including procedural steps, anesthesia protocols, intraoperative considerations, or post-operative
care guidelines in the methodology section is essential.
The results section is well-structured and presents the key findings in a logical sequence.
However, some of the reported findings lack sufficient explanation. For instance, while it is
stated that surgical intervention significantly reduced recurrence rates, the exact mechanisms
underlying this difference should be discussed in greater detail. Moreover, the significance of
shorter recovery times in the conservative treatment group should be further explored in relation
to patient quality of life and long-term prognosis. While the study reports that perianal infections
were more prevalent in male patients, the manuscript does not adequately discuss potential
explanations for this finding. Including possible biological or behavioral factors contributing to
this disparity would provide a more comprehensive interpretation of the results.
The tables and figures are generally well-organized and informative. However, Figure 4, which
details antibiotic usage between the surgical and conservative treatment groups, could benefit
from additional explanation in the text. Clarifying whether antibiotic selection was standardized
based on institutional protocols or varied depending on clinician preference would strengthen
the interpretation of these results. Additionally, Figure 3, which depicts clinical appearances and
surgical procedures, would be more effective with brief annotations describing key observations
for readers unfamiliar with perianal abscess management.
In the discussion section, your manuscript provides a balanced evaluation of the benefits and
limitations of both treatment approaches. However, a more in-depth discussion regarding the
microbiological findings would be beneficial. The study notes that Klebsiella pneumoniae and
Escherichia coli were the most commonly isolated pathogens, but further elaboration on their
resistance profiles and the implications for empirical antibiotic therapy in immunocompromised
patients would add depth to this section. The manuscript would also benefit from an
expanded discussion on the potential risks of surgical intervention in patients with hematologic
malignancies, particularly regarding post-operative complications such as bleeding and delayed
wound healing.
Additionally, discussing possible confounding factors, such as variations in disease severity at
presentation and differences in supportive care measures, would enhance the robustness of the
conclusions.
Finally, while the manuscript effectively highlights the clinical implications of the findings, the
conclusion could be strengthened by providing clearer recommendations for future research.
Given the observed differences in recurrence rates and recovery times, prospective multicenter
studies with larger sample sizes and standardized treatment protocols would be valuable in
further elucidating the optimal management approach for perianal abscess in this patient
population.
Kind Regards,