Reviewer’s report
Title: 
Resection of inferior vena cava, abdominal aorta, bilateral common iliac
arteries, and bilateral partial external iliac arteries with artificial vessel
replacement during radical endometrial cancer surgery: A case report
Version: 
0 
Date: 
04 Oct 2022
Reviewer's report:
Thank you for the opportunity to review this care report on the first major blood
vessel transection and replacement as part of debulking surgery for uterine
cancer with metastases to lymph nodes. I have the following comments.
1. Lines 79-80 Please provide your institutional normals.
2. Please provide more details about the patient ie., gender, race, BMI or height
and weight, other major medical issues, medication, prior surgeries, family
history of cancer.
3. In your health care system, who pays for care: surgery, consults, ICU ect
4. Line 97-99 It would be more helpful to provide histologic information like,
histology, grade, LVSI, lower uterine segment involvement, depth of invasion
ect You attempt to do this in lines 117-125 but the wording needs to be clearer.
5. Line 106 - I believe you mean "blood loss" was 2950ml/ 
6. Line 109 - I believe you mean "she" not "he".
7. What investigations were done preop - Endometrial biopsy and findings, CXR
or Chest CT scan and findings, PET and findings ect.
8. Line 112-116: It sounds like the patient had a major complication. In line 110
was the patient on LMW heparin for 1 mos at 4000 bid???? How was the
complete thrombosis handled?
9. Line 125 is a new paragraph. It is not clear if this patient received pelvic
radiation or pelvic and a para-aortic chimney or high dose rate brachy. Please
clarify. 
10. Line 159-161 makes it sound like the patient had a laparotomy to assess
whether the nodes were resectable. Is this correct? please clarify how you made
the assessment that the nodes were not resectable.
11. Since this is a case report of a new concept in uterine cancer, Line 171
should use the adjective "rare" not "less commonly". 
12. Molecular typing section should follow the pathologic assessment of the
tumor. Not clear from what is reported here - has patient had genetic testing, is
she Lynch Syndrome, is she undergoing any screening for other cancers like
colorectal disease?
13. Ethics of this care: The discussion needs to address the issues of "Just
because we can do a procedure like this" - "should we offer such procedures and
to whom". Endometrial cancer is extremely common. Offering a 10hr operation
to one person means 3 other patients did not receive surgery that could have been
curative that day. Or the health care system in China has plenty of access to OR
resources and surgical wait times are not an issue. 
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