Review for 10.1186/1471-230X-11-85 (2011)

Reviewer's report
Title:Short-term and Medium-term Clinical Outcomes of Laparoscopic-assisted
and Open Surgery for Colorectal Cancer: A Single Center Retrospective
Case-control Study
Version: 3Date:26 January 2011
Reviewer: jonas nygren
Reviewer's report:
This is a paper on 519 patients undergoing open or laparascopic resection for
colorectal cancer in one institution. The subjects were evaluated for short and
medium term outcome. LAP group had improved early recovery and no change
was found in oncological outcome.
I assume that this is consecutive patients (ie all patients admitted to the hospital
during this time). However, if so, this need to be stated in methods.
The paper, although well written, really need proof reading for english syntax,
grammar and spelling.
There may be substantial differences in the perioperative treament of patients in
LAP vs open group, which may confound interpretation of results in early
recovery. The authors should ad information on the perioperative routines used
in association with surgery, and how the routines differed in LAP vs open group.
(ie preop fasting, bowel prep, fluid management, drains, mobilisation and postop
feeding). If there is no such data, this anyway need to be discussed along with
the results from early recovery. This is also illustrated by the fact that oral intake
could not be given due to differences in treatment. My point is that for that
reason, it is important to provide data on perioperative treatment since they have
a large impact on postop outcome (see paper by Ulf Gustafsson, Epub, 2011,
Arch Surg)
Also, even if there is a difference in hospital stay, recovery is quite prolonged in
both groups, especially if compared with groups using enhanced recovery
perioperative protocols (see ref above). This should be discussed, since it may
be due to the perioperative treatment of the patients.
The power of the study (ie number of patients needed) to determine differences
in outcome, (especially anastomotic leaks, mortality and oncological outcome),
should be discussed. There may be too few patients included to allow the
authors to make a generalized statement about LAP vs open resection. This
need to be discussed in the paper.
I also think that a more thourough multivariate analysis of the early outcome
should be performed, and not just univariate analysis. Important since this is not
a randomised trial, and that there probably are some differences in case mix and
perioperative treatment between patients undergoing LAP vs open surgery.
Anastomotic leaks (in LAR) were 29% in LAP (5/17 undergoing LAR) vs 15%
(4/26) in open group. Is this significant ? Power-related? This apparent difference
between the groups should be discussed.
Table 4. Fluid and semi-fluid. What is this ? This need to be explained in text
Usually in the literature, total hospital stay means including hospital stay during
readmissions. Data on readmissions (within 30 postop days) should be given,
and total hospital stay should included also this time.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests'