Reviewer ’s report  
 
Title: Lesion distribution characteristics of deep infiltrating endometriosis with ovarian  
endometrioma: An observational clinical study  
 
Version: 0 Date: 02 Feb 2020  
 
Reviewer: Antti H. Perheentupa  
 
Reviewer's report:  
 
The patient records of 304 patients operated by a single surgeon in a single center were evaluated 
retrospectively.  
 
Patient who had both ovarian endometriosis as well as deep infiltrating endometriosis were  
evaluated.  
 
Medical, surgical and pathological records were evaluated. There are several important data 
missing from the manuscript.  
 
It would appear that the patients were carefully evaluated before the surgery as the extensive 
preoperative tests included  transvaginal sonography, urological ultrasound as well as MRI.  
The symptoms are carefully listed, however nothing is mentioned about the medical treatment 
that the patients received prior to the surgery. In most (if not all ) guidelines the medical 
treatm ent should be the primary form of treatment and only if no sufficieint relief is observed 
then surgical interventions should be used.  
 
It appears that during the period of 2008 - 2016 a large number of cases with ovarian disease 
only may have /(probably) have been operated. How many cases of unilateral ovarian 
endometriosis with no DIE were operated during that period? How many cases of bilateral cases 
of ovarian endometriosis with no DIE were operated during that period? How many of these 
were symptom les s or had very little symptoms (compared to the one with DIE), This was enable 
the evaluation of the importance of symptoms in suspicion of DIE. Whereas the symptoms have 
been documented, there is no effort to find an association with specific symptoms and the 
location of the DIE. Not being familiar with the Chinese patient records and the reliability of 
details it is not possible to estimate whether this could be possible, certainly in many centers the 
routine surgical and medical notes are unlikely to give  reliable and detailed information on this 
important issues.  
As the goal in the study is to investigate the association between DIE and unilateral and bilateral 
OEM why has the imaging been completely ignored in this study? Would the findings be 
different if the analysis was done solely based on the imaging findings? Did the imaging findings 
match the surgical findings?  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported  by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
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 spec ify 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 manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please compl ete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of th is 
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 applyi ng 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 all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is y es to any, please give details below.  
 
declare that I have  no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for public ation, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/b y/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal