Title: Low Hartmann’s procedure versus abdominoperineal resection for rectal cancer, a
propensity score matching cohort study
Version: 1 Date: 23 Jan 2024
Reviewer's report:
Dear Authors,
I have read the manuscript with great interest since the complications secondary to the APR
surgery are not negligible, as well as the quality of life of the patients who receive this treatment.
The manuscript is well structured and written and the results, despite being a retrospective work,
are interesting and provide useful data so that surgeon and patient can share the most appropriate
therapeutic decision.
Regarding the methodology and results, I would like the authors to try to clarify some issues:
1. In the methodology, the Authors have analyzed short-term (< 90 days) and long-term
complications, defining “long term” as a time more than 90 days. The maximum follow-up time
is not specified; a complication that occurs within less than a year should be considered medium-
term; It is possible that patients from both groups have developed a parastomal hernia 2-3 years
after the intervention... For all this, it is suggested to add the maximum follow-up time of the
patients and talk about complications in the short and medium-long term ( > 90 days).
2. Minor complications have been significantly lower in the LHP group; Surprisingly, perineal
wound infection in APR has been only 4.8% and 50% lower than abdominal infection in LHP:
therefore, in your experience, avoiding a perineal wound with LHP does not seem to be an
advantage.
3. How do you explain such a low rate of perineal infection compared to the literature?
The percentage of patients undergoing APR after neoadjuvant RT treatment was 5%: this
data is striking, since APR is usually indicated in more locally advanced tumors. Can the
authors explain why so few patients underwent preoperative RT? RT significantly increases
postoperative complications, especially in terms of wound infection and delayed healing:
perhaps the lack of differences in major complications between LHP and APR is due to that:
what do you think about it?
4. Pelvic abscess has been defined as a minor complication; However, the clinical repercussion,
the need for drainage and the increase in hospital stay that this complication entails, justify its
definition more properly as a major complication: what do you think about it?
5. Legend Fig.1: add PSM abbreviation.
Title: Low Hartmann’s procedure versus abdominoperineal resection for rectal cancer, a
propensity score matching cohort study
Version: 1 Date: 23 Jan 2024
Reviewer's report:
Dear Authors,
I have read the manuscript with great interest since the complications secondary to the APR
surgery are not negligible, as well as the quality of life of the patients who receive this treatment.
The manuscript is well structured and written and the results, despite being a retrospective work,
are interesting and provide useful data so that surgeon and patient can share the most appropriate
therapeutic decision.
Regarding the methodology and results, I would like the authors to try to clarify some issues:
1. In the methodology, the Authors have analyzed short-term (< 90 days) and long-term
complications, defining “long term” as a time more than 90 days. The maximum follow-up time
is not specified; a complication that occurs within less than a year should be considered medium-
term; It is possible that patients from both groups have developed a parastomal hernia 2-3 years
after the intervention... For all this, it is suggested to add the maximum follow-up time of the
patients and talk about complications in the short and medium-long term ( > 90 days).
2. Minor complications have been significantly lower in the LHP group; Surprisingly, perineal
wound infection in APR has been only 4.8% and 50% lower than abdominal infection in LHP:
therefore, in your experience, avoiding a perineal wound with LHP does not seem to be an
advantage.
3. How do you explain such a low rate of perineal infection compared to the literature?
The percentage of patients undergoing APR after neoadjuvant RT treatment was 5%: this
data is striking, since APR is usually indicated in more locally advanced tumors. Can the
authors explain why so few patients underwent preoperative RT? RT significantly increases
postoperative complications, especially in terms of wound infection and delayed healing:
perhaps the lack of differences in major complications between LHP and APR is due to that:
what do you think about it?
4. Pelvic abscess has been defined as a minor complication; However, the clinical repercussion,
the need for drainage and the increase in hospital stay that this complication entails, justify its
definition more properly as a major complication: what do you think about it?
5. Legend Fig.1: add PSM abbreviation.
Please review this paper.
user
Title: Low Hartmann’s procedure versus abdominoperineal resection for rectal cancer, a
propensity score matching cohort study
Version: 1 Date: 23 Jan 2024
Reviewer's report:
Dear Authors,
I have read the manuscript with great interest since the complications secondary to the APR
surgery are not negligible, as well as the quality of life of the patients who receive this treatment.
The manuscript is well structured and written and the results, despite being a retrospective work,
are interesting and provide useful data so that surgeon and patient can share the most appropriate
therapeutic decision.
Regarding the methodology and results, I would like the authors to try to clarify some issues:
1. In the methodology, the Authors have analyzed short-term (< 90 days) and long-term
complications, defining “long term” as a time more than 90 days. The maximum follow-up time
is not specified; a complication that occurs within less than a year should be considered medium-
term; It is possible that patients from both groups have developed a parastomal hernia 2-3 years
after the intervention... For all this, it is suggested to add the maximum follow-up time of the
patients and talk about complications in the short and medium-long term ( > 90 days).
2. Minor complications have been significantly lower in the LHP group; Surprisingly, perineal
wound infection in APR has been only 4.8% and 50% lower than abdominal infection in LHP:
therefore, in your experience, avoiding a perineal wound with LHP does not seem to be an
advantage.
3. How do you explain such a low rate of perineal infection compared to the literature?
The percentage of patients undergoing APR after neoadjuvant RT treatment was 5%: this
data is striking, since APR is usually indicated in more locally advanced tumors. Can the
authors explain why so few patients underwent preoperative RT? RT significantly increases
postoperative complications, especially in terms of wound infection and delayed healing:
perhaps the lack of differences in major complications between LHP and APR is due to that:
what do you think about it?
4. Pelvic abscess has been defined as a minor complication; However, the clinical repercussion,
the need for drainage and the increase in hospital stay that this complication entails, justify its
definition more properly as a major complication: what do you think about it?
5. Legend Fig.1: add PSM abbreviation.
assistant