Title: Thrombosis of acute superior mesenteric artery in a patient with breast cancer receiving
toremifene therapy: a case report and literature review
Version: 2 Date: 06 Nov 2023
Reviewer's report:
Background section
Provides a good overview of the topic and highlights the importance of early diagnosis and
treatment of SMAT.
Here is a suggestion for improvement:
In the final paragraph, the phrase "we suggest that during the use of toremifene, not only the
occurrence of venous thrombosis should be closely monitored, but also the risk of arterial
thrombosis, especially ATSP should be pay attention" could be rewritten as "we suggest that
during toremifene therapy, clinicians should be vigilant for the occurrence of both venous and
arterial thrombosis, especially in unusual locations."
Case report section
Provides a clear and concise overview of the patient's presentation, diagnosis, and treatment.
Here is a suggestion for improvement:
The phrase "She stopped toremifene treatment after the surgery of SMAT, and no abnormality
was found in the follow-up until now" could be rewritten as "toremifene therapy was
discontinued after surgery, and the patient has had no further thrombotic events during follow-
up." Also, consider adding the duration of the follow-up.
I would also recommend that the authors consider clarifying the following in the case report
section:
The patient's risk factors for SMAT, other than toremifene use.
The differential diagnosis of the patient's presentation.
The findings of the patient's imaging studies, such as CT angiography.
The patient's postoperative course and recovery.
Literature review section
Provides a comprehensive overview of the current literature on ATSP caused by toremifene.
Here are a few suggestions for improvement:
In the first paragraph, the phrase "but ATSP caused by toremifene was rare, only several case
reports" could be replaced with "but ATSP caused by toremifene is rare, with only a handful
of case reports published to date."
In the third paragraph, the phrase "we can found their age of ATSP onset were about 50 years
old (mean age 52), and the medication time from 1 week to several years" could be rewritten
as "the mean age of ATSP onset was 52 years, and the duration of tamoxifen treatment ranged
from 1 week to several years."
Discussion section
Provides a good summary of the key findings of the case report and literature review.
Here are suggestions for improvement:
In the first paragraph, the phrase "Acute SMAT is rare, which is one of the causes of acute
mesenteric ischemia (AMI). The incidence is estimated at 0.09-0.2% of all acute surgical
admissions" could be replaced with "Acute SMAT is a rare cause of AMI, with an estimated
incidence of 0.09-0.2% of all acute surgical admissions."
In the third paragraph, the phrase "This means that endocrinotherapy has some influence on
arterial thrombosis" could be replaced with "This suggests that endocrinotherapy may increase
the risk of arterial thrombosis."
I would also recommend that the authors consider clarifying the following:
Limitations of the study.
Suggesting directions for future research to identify the optimal strategies for preventing and
treating endocrine therapy-related ATSP.