Reviewer ’s report  
 
Title: Risk factors and a prediction model for lower limb lymphedema following 
lymphadenectomy  in gynecologic cancer: a hospital -based retrospective cohort study  
 
Version: 0 Date: 29 Sep 2016  
 
Reviewer: Redhwan Al -Naggar  
 
Reviewer's report:  
 
The authors did a great job in this study. This study should be highlighted in the major news 
channels and newspapers for the important findings. The strength of this study are many, the 
long period of retrospective study, the uniqueness of the topic and n o prediction model for LLL 
has been reported so far. However, very extensive revision needed before the final acceptance 
due to the following shortcoming:  
 
 
 
 
- Sample size not calculated scientifically so the conclusion can represent the whole 
population.  
 
 
 
- The authors mentioned in the results the statistically significant findings and not focusing 
on clinical significant findings which is more important clinically.  
 
 
 
- The discussion part is very shallow and need more deep scientific discussion and many 
repeti tions and no flow for the readers, discussion part need to be rewritten.  
 
 
 
- In the discussion section page 9 line 3, the authors mentioned " However, the analysis of 
31 patients in whom infection occurred before and after LLL indicated a strong positive 
correlation..." Separate table should be elaborate this 31 patients demographic and 
clinical data.  
 
 
 
- Authors mentioned at page 9 line 15 that "we administered goshajinkigan to patients 
experiencing numbness...., but were unable to confirm its efficacy." is this a clinical trail 
study?  
 
- page 10 paragraph started with line 4 the justification is very superficial and more in -
depth explanation needed.  
 
 
 
- -page 10 line 12, the authors mentioned many limitations  
 
 
 
 
1]retrospective nature    
 
2]single center  
 
3]sample si ze 
 
4]diagnostic bias  
 
For number 1 is OK, but for number 2 many information is lacking about the center that the 
study conducted in. It is a central hospital for women oncology, number of patients compared to 
other center, the number of specialist in this c enter compare to another once. Many usufule 
information need to be clarified on this point.  
 
for number 3 sample size need to be calculated before conducting any study so we can generalize 
the study for this population.  
 
 
for number 4 the authors explained t he point well.  
 
 
moreover, i would like to highlight  on very important issue in the conclusion part, I agree with 
the team that the information provided by this study can be used to improve the QOL. However, 
my question is did you measure the qol? What ins trument you used? the duration of fiollow up of 
QOL?  
 
 
 
- For the references section, most of the references are up to date however, references 
5,7,8,9, 10, 11, 12, 17, 18, 1921, 22, 24, 32, 33, 35, 36, 39, 40, 47, and 48 need to have 
more recent and updated o nce.  
 
 
- for tables the design of tables is very complicated and confusing.  
 
 
- the p -value should be written 0.038 and not 0.038 in all tables.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments t o the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review ? 
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manus cript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, fu nding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to al l of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
  
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