Review for 10.1186/s12876-015-0301-7 (2015)

Reviewer's report
Title:Laparoscopic colonic resection for splenic flexure cancer: our experience.
Version:3Date:16 February 2014
Reviewer: Jan-Sing Hsieh
Reviewer's report:
Major Compulsory Revisions
The author presents their experience on laparoscopic colonic resection for
splenic flexure cancer. This is a non-randomized, non-controlled cases analysis
on clinical outcomes in a small group of splenic flexure (SF) cancer. There are
only a few studies regarding laparoscopic treatment on SF cancer in the
literature. However, after meticulously reviewing this manuscript several
concerns have been raised as described in the following
1. The author mentioned that in no case was an oral mechanical bowel
preparation given although they were treated preoperatively with short-term IV
prophylactic antibiotic. was this the conditions with partial SF obstruction or
chronic constipation? Were all four patients with intracorporeal anastomosis
treated without any oral mechanical bowel preparation before surgery? This
needs to be discussed.
2. In “result” the author described that the mean follow-up was 20 months (range:
5 years-5 months) and the long term mortality was 0%. It seems to be difficult to
appreciate this inference since the follow-up period is too short to make the
long-term conclusion. The purpose of this study was to assess the early and
medium- term outcomes not the long-term result.
3. In “result”, the differences between intracorporeal suturing and extracorporeal
anastomosis have been compared in terms of the length of the laparotomy
wound for specimen extraction and the operation time. However, for extracting
the surgical specimen the tumor of great bulk would make a larger incision
wound. Therefore, the diameter of the tumor would determine the size of the
laparotomy wound, not the length of the surgical specimen. What were the tumor
sizes in these patients? Was there any concern in patients with intracorporeal
anastomosis having a suprapubic wound for tissue extraction not a left
hypocondrium incision? What were the periods of hospital stay between this two
groups?
4. In this study all patients underwent ligation of both the left branch of the middle
colic artery and the left colic artery at their origin. It was concluded that there
were no significant differences in complications or conversion rates compared to
patients who underwent laparoscopic resection of other colic segments. It is hard
to accept this conclusion since supporting data and information concerning
outcomes of laparoscopic surgery in other colonic segments was not included in
the text.
5. The observation that Laparoscopic partial resection seems to be feasible and
safe for the treatment of early-stage and locally advanced SF cancer has been
reported recently. (Ceccarelli G et al Surg Endosc 2010: 24:1784–1788). The
findings of the present study essentially provides little new message to the
readers.
Minor Essential Revisions
1. Too many tables and they can be integrated into one or two tables
2. The study period is different between “result” and “material and method”.
3. The manuscript, although well written, really need proof reading for English
syntax, grammar and spelling.-- Trendelemburg position,--for remove the small,-
with a continue intracorporeal suture,-colic resection------
4. The data were not standardized with a Mean ±SD or Median±SD in “result”.,--
medium operative time was 250 min?
Discretionary Revisions
1. Placement of the trocar would be more clearly understood by including an
illustration if available.
2. Photos for intracorporeal anastomosis would strength the safety and feasibility
of this technique.
Level of interest: An article whose findings are important to those with closely
related research interests
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:
No conflict of competing interests