Reviewer ’s report  
Title: Efficacy and safety outcomes of robotic radical hysterect omy in Chinese older women 
with cervical cancer compared with laparoscopic radical hysterectomy  
 
Version: 0 Date: 03 Sep 2017  
 
Reviewer: Rema Iyer  
 
Reviewer's report:  
Cervical cancer is common in women of the reproductive age and the median age is around 45 
years world wide. However, in the introduction, it has been mentioned that cervical cancer is one 
of the most common malignant tumours in elderly w omen - Is this in China or world wide? 
Please clarify.  
 
The age range of the cohort was 61 -69 years. Was this study limited to women above 60 years?  
 
Under methods, in the surgical techniques section, it has been mentioned that all patients 
underwent chemot herapy and pelvic radiotherapy. Was this also the case for all women with 
Stage 1A and Stage 1B1 tumours? In the UK, radical hysterectomy is usually not offered if it is 
felt that patients would require adjuvant treatment postoperatively, to reduce the mor bidity from 
radical surgery and then radiotherapy.  
 
Also I note that there were twelve patients with FIGO stage 1A tumours who had radical 
hysterectomy. In the UK, microinvasive cancers (FIGO 1A1) would be treated with large loop 
excision or a cone biopsy  and most 1A2 cancers would be treated with a simple hysterectomy + 
lymph node dissection.  
 
It was interesting to note that the indwelling drain remained in situ for between 29 and 32 days - 
what was the reason for this?  
 
The length of hospital stay averag ed between 13 and 17 days - why were the patients in hospital 
for this length of time, when one of the main advantages of minimal access surgery is early 
recovery and reduced length of hospital stay?  
 
Do the authors have any thoughts as to why there were mo re complications in the laparoscopic 
group?  
 
Overall even though the data in this study does suggest that robotically assisted radical 
hysterectomy had fewer complications, the authors have not made a convincing case to suggest 
that this route is superior  over laparoscopy.  
 
In the tables it needs to be clarified if it is the median or the mean that the authors are referring 
to.  
 
Overall, this paper is a good effort to compare the two methods. However I do feel that the points 
above need to be addressed b efore publication.  
 
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 to the authors.  
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
No 
Are you able to assess any statistics in th e manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
I recommend additional statistical review  
Quality of wri tten English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
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