Reviewer ’s report  
Title: Proper Bile Duct Flow, Rather Than Radical Excisi on, is the Most Critical F actor 
Determining Treatme nt Outcomes of Bile Duct Cysts  
 
Version: 1 Date: 11 Apr 2018  
 
Reviewer: Tianquan Han  
 
Reviewer's report:  
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated ver sions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your comments to the authors.  
The present manuscript titled 'Proper Bile Duct Flow, Rather Than Radical Excision, is the Most 
Critical Factor Determining Treatment Outcomes of Bile Duct Cysts' by Hong -Tian Xia et al 
studied the effects of extent of excision and patent bile duct flow on surgical treatment of bile 
duct cysts by the retrospective a nalysis of 382 cases and the companion of the surgical modes. 
This manuscript presents some interesting findings.  
 
Major point:  
The authors have mentioned on first paragraph page 6 that 'Efficacy was based on the Mayo 
clinic score [22]', however the author s of reference 22 were from Virginia Mason Medical Center 
Seattle not from Mayo and there was no reference from Mayo clinic.  
 
Minor points:  
1. On page 7 third paragraph of results, it stated that 'poor long -term postoperative biliary 
function (excellent + good, 14.2%)', however percentage should be 14.3% (2/14).  
2. On page 8 last paragraph of results, 'As shown in Table 5, incomplete excision was a 
significant risk factor for late complications and poor …', but there is no 'poor biliary 
function' in Table  5 and so without 'P<0.05' and without 'poor biliary function in both Type 
Ia (P<0.0001) and Type Ⅳa bile duct cyst patients (P<0.0001)'.  
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 supporte d by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please spe cify 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:  
Not suitable for publication unless extensively edited  
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, funding, or salary from an  
organisation that may in any way gain or  lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
The present manuscript titled ‘Proper Bile Duct Flow, Rather Than Radical Excision, is the Most 
Critical Factor Determining Tr eatment Outcomes of Bile Duct Cysts’ by Hong -Tian Xia et al 
studied the effects of extent of excision and patent bile duct flow on surgical treatment of bile 
duct cysts by the retrospective analysis of 382 cases and the companion of the surgical modes. 
This manuscript presents some interesting findings.  
 
Major point:  
The authors have mentioned on first paragraph page 6 that ‘Efficacy was based on the Mayo 
clinic score [22]’, however the authors of reference 22 were from Virginia Mason Medical 
Center Seattle not from Mayo and there was no reference from Mayo clinic.  
 
Minor points:  
1. On page 7 third paragraph of results, it stated that ‘poor long -term postoperative biliary 
function (excellent + good, 14.2%)’, however percentage should be 14.3% (2/14).  
2. On page 8 last paragraph of results, ‘As shown in Table 5, incomp lete excision was a 
significant risk factor for late complications and poor …’, but there is no ‘poor biliary 
function’ in Table 5 and so without ‘P<0.05’ and without ‘poor biliary function in both Type 
Ia (P<0.0001) and Type Ⅳa bile duct cyst patients (P< 0.0001)’.  
 
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 publication, 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/by/4.0/ ). I understand that any comments 
which I do not wish to be included i n 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  
Reviewer ’s report  
Title: Proper Bile Duct Flow, Rather Than Radical Excisi on, is the Most Critical F actor 
Determining Treatme nt Outcomes of Bile Duct Cysts  
 
Version: 1 Date: 11 Apr 2018  
 
Reviewer: Tianquan Han  
 
Reviewer's report:  
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated ver sions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your comments to the authors.  
The present manuscript titled 'Proper Bile Duct Flow, Rather Than Radical Excision, is the Most 
Critical Factor Determining Treatment Outcomes of Bile Duct Cysts' by Hong -Tian Xia et al 
studied the effects of extent of excision and patent bile duct flow on surgical treatment of bile 
duct cysts by the retrospective a nalysis of 382 cases and the companion of the surgical modes. 
This manuscript presents some interesting findings.  
 
Major point:  
The authors have mentioned on first paragraph page 6 that 'Efficacy was based on the Mayo 
clinic score [22]', however the author s of reference 22 were from Virginia Mason Medical Center 
Seattle not from Mayo and there was no reference from Mayo clinic.  
 
Minor points:  
1. On page 7 third paragraph of results, it stated that 'poor long -term postoperative biliary 
function (excellent + good, 14.2%)', however percentage should be 14.3% (2/14).  
2. On page 8 last paragraph of results, 'As shown in Table 5, incomplete excision was a 
significant risk factor for late complications and poor …', but there is no 'poor biliary 
function' in Table  5 and so without 'P<0.05' and without 'poor biliary function in both Type 
Ia (P<0.0001) and Type Ⅳa bile duct cyst patients (P<0.0001)'.  
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 supporte d by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please spe cify 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:  
Not suitable for publication unless extensively edited  
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, funding, or salary from an  
organisation that may in any way gain or  lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
The present manuscript titled ‘Proper Bile Duct Flow, Rather Than Radical Excision, is the Most 
Critical Factor Determining Tr eatment Outcomes of Bile Duct Cysts’ by Hong -Tian Xia et al 
studied the effects of extent of excision and patent bile duct flow on surgical treatment of bile 
duct cysts by the retrospective analysis of 382 cases and the companion of the surgical modes. 
This manuscript presents some interesting findings.  
 
Major point:  
The authors have mentioned on first paragraph page 6 that ‘Efficacy was based on the Mayo 
clinic score [22]’, however the authors of reference 22 were from Virginia Mason Medical 
Center Seattle not from Mayo and there was no reference from Mayo clinic.  
 
Minor points:  
1. On page 7 third paragraph of results, it stated that ‘poor long -term postoperative biliary 
function (excellent + good, 14.2%)’, however percentage should be 14.3% (2/14).  
2. On page 8 last paragraph of results, ‘As shown in Table 5, incomp lete excision was a 
significant risk factor for late complications and poor …’, but there is no ‘poor biliary 
function’ in Table 5 and so without ‘P<0.05’ and without ‘poor biliary function in both Type 
Ia (P<0.0001) and Type Ⅳa bile duct cyst patients (P< 0.0001)’.  
 
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 publication, 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/by/4.0/ ). I understand that any comments 
which I do not wish to be included i n 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  
Please review this paper.
user
Reviewer ’s report  
Title: Proper Bile Duct Flow, Rather Than Radical Excisi on, is the Most Critical F actor 
Determining Treatme nt Outcomes of Bile Duct Cysts  
 
Version: 1 Date: 11 Apr 2018  
 
Reviewer: Tianquan Han  
 
Reviewer's report:  
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated ver sions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your comments to the authors.  
The present manuscript titled 'Proper Bile Duct Flow, Rather Than Radical Excision, is the Most 
Critical Factor Determining Treatment Outcomes of Bile Duct Cysts' by Hong -Tian Xia et al 
studied the effects of extent of excision and patent bile duct flow on surgical treatment of bile 
duct cysts by the retrospective a nalysis of 382 cases and the companion of the surgical modes. 
This manuscript presents some interesting findings.  
 
Major point:  
The authors have mentioned on first paragraph page 6 that 'Efficacy was based on the Mayo 
clinic score [22]', however the author s of reference 22 were from Virginia Mason Medical Center 
Seattle not from Mayo and there was no reference from Mayo clinic.  
 
Minor points:  
1. On page 7 third paragraph of results, it stated that 'poor long -term postoperative biliary 
function (excellent + good, 14.2%)', however percentage should be 14.3% (2/14).  
2. On page 8 last paragraph of results, 'As shown in Table 5, incomplete excision was a 
significant risk factor for late complications and poor …', but there is no 'poor biliary 
function' in Table  5 and so without 'P<0.05' and without 'poor biliary function in both Type 
Ia (P<0.0001) and Type Ⅳa bile duct cyst patients (P<0.0001)'.  
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 supporte d by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please spe cify 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:  
Not suitable for publication unless extensively edited  
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, funding, or salary from an  
organisation that may in any way gain or  lose financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
The present manuscript titled ‘Proper Bile Duct Flow, Rather Than Radical Excision, is the Most 
Critical Factor Determining Tr eatment Outcomes of Bile Duct Cysts’ by Hong -Tian Xia et al 
studied the effects of extent of excision and patent bile duct flow on surgical treatment of bile 
duct cysts by the retrospective analysis of 382 cases and the companion of the surgical modes. 
This manuscript presents some interesting findings.  
 
Major point:  
The authors have mentioned on first paragraph page 6 that ‘Efficacy was based on the Mayo 
clinic score [22]’, however the authors of reference 22 were from Virginia Mason Medical 
Center Seattle not from Mayo and there was no reference from Mayo clinic.  
 
Minor points:  
1. On page 7 third paragraph of results, it stated that ‘poor long -term postoperative biliary 
function (excellent + good, 14.2%)’, however percentage should be 14.3% (2/14).  
2. On page 8 last paragraph of results, ‘As shown in Table 5, incomp lete excision was a 
significant risk factor for late complications and poor …’, but there is no ‘poor biliary 
function’ in Table 5 and so without ‘P<0.05’ and without ‘poor biliary function in both Type 
Ia (P<0.0001) and Type Ⅳa bile duct cyst patients (P< 0.0001)’.  
 
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 publication, 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/by/4.0/ ). I understand that any comments 
which I do not wish to be included i n 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  
assistant