Title: Biliary Drainage in Palliative and Curative Intent European Patients with Hilar
Cholangiocarcinoma and malignant hilar obstruction: a retrospective single center analysis
Version: 4 Date: 04 Aug 2024
Reviewer:  Naminatsu Takahara
Reviewer's report:
Thank you very much for giving me the opportunity to review the paper titled "Biliary
Drainage in Palliative and Curative Intent European Patients with Hilar Cholangiocarcinoma
and Malignant Hilar Obstruction: A Retrospective Single Center Analysis." While I appreciate
the effort and significance of better biliary drainage results in patients with curative disease, I
believe the authors need to provide more information on the methods used to improve the paper.
1. The authors stated that the decision on therapy concepts (curative versus palliative) was
discussed in the hospital’s interdisciplinary tumor board. However, the criteria for determining
curative versus palliative disease in the tumor board remain unclear.
2. The authors used four alternative definitions of clinical success as bilirubin decrease in this
study. However, the major aim of biliary drainage should be not only to reduce jaundice but
also to provide opportunities for antitumor therapy, avoid biliary events such as cholangitis, and
maintain quality of life (QoL). Shouldn't the appropriateness of the treatment be evaluated using
outcomes that reflect these goals?
3. Please describe the treatment content and strategies after biliary drainage for both curative
and palliative diseases. If the treatment strategies differ between the two groups after biliary
drainage, it is likely that the observation periods between the two groups will differ. Therefore,
please clarify the observation periods for both groups.
4. Differences in patient backgrounds and observation periods can impact treatment outcomes
(i.e., the longer the observation period, the higher the likelihood of increased reintervention rates
due to stent occlusion, whereas the shorter the observation period, the higher the likelihood of
underestimating the frequency of complications). Comparing treatment outcomes between these
two groups with different patient backgrounds requires careful interpretation. This should be
clearly stated as a major limitation of this study.
5. It is desirable to evaluate adverse events by dividing them into early (within 2 weeks) and
late (after 2 weeks) occurrences.
6. Please confirm the timing of the evaluation of clinical success.
7. In Table 2, the number of procedures is noted, but over what period were these procedures
performed? Are reinterventions for stent occlusion also counted? The results may vary
depending on the observation period.
Title: Biliary Drainage in Palliative and Curative Intent European Patients with Hilar
Cholangiocarcinoma and malignant hilar obstruction: a retrospective single center analysis
Version: 4 Date: 04 Aug 2024
Reviewer:  Naminatsu Takahara
Reviewer's report:
Thank you very much for giving me the opportunity to review the paper titled "Biliary
Drainage in Palliative and Curative Intent European Patients with Hilar Cholangiocarcinoma
and Malignant Hilar Obstruction: A Retrospective Single Center Analysis." While I appreciate
the effort and significance of better biliary drainage results in patients with curative disease, I
believe the authors need to provide more information on the methods used to improve the paper.
1. The authors stated that the decision on therapy concepts (curative versus palliative) was
discussed in the hospital’s interdisciplinary tumor board. However, the criteria for determining
curative versus palliative disease in the tumor board remain unclear.
2. The authors used four alternative definitions of clinical success as bilirubin decrease in this
study. However, the major aim of biliary drainage should be not only to reduce jaundice but
also to provide opportunities for antitumor therapy, avoid biliary events such as cholangitis, and
maintain quality of life (QoL). Shouldn't the appropriateness of the treatment be evaluated using
outcomes that reflect these goals?
3. Please describe the treatment content and strategies after biliary drainage for both curative
and palliative diseases. If the treatment strategies differ between the two groups after biliary
drainage, it is likely that the observation periods between the two groups will differ. Therefore,
please clarify the observation periods for both groups.
4. Differences in patient backgrounds and observation periods can impact treatment outcomes
(i.e., the longer the observation period, the higher the likelihood of increased reintervention rates
due to stent occlusion, whereas the shorter the observation period, the higher the likelihood of
underestimating the frequency of complications). Comparing treatment outcomes between these
two groups with different patient backgrounds requires careful interpretation. This should be
clearly stated as a major limitation of this study.
5. It is desirable to evaluate adverse events by dividing them into early (within 2 weeks) and
late (after 2 weeks) occurrences.
6. Please confirm the timing of the evaluation of clinical success.
7. In Table 2, the number of procedures is noted, but over what period were these procedures
performed? Are reinterventions for stent occlusion also counted? The results may vary
depending on the observation period.
Please review this paper.
user
Title: Biliary Drainage in Palliative and Curative Intent European Patients with Hilar
Cholangiocarcinoma and malignant hilar obstruction: a retrospective single center analysis
Version: 4 Date: 04 Aug 2024
Reviewer:  Naminatsu Takahara
Reviewer's report:
Thank you very much for giving me the opportunity to review the paper titled "Biliary
Drainage in Palliative and Curative Intent European Patients with Hilar Cholangiocarcinoma
and Malignant Hilar Obstruction: A Retrospective Single Center Analysis." While I appreciate
the effort and significance of better biliary drainage results in patients with curative disease, I
believe the authors need to provide more information on the methods used to improve the paper.
1. The authors stated that the decision on therapy concepts (curative versus palliative) was
discussed in the hospital’s interdisciplinary tumor board. However, the criteria for determining
curative versus palliative disease in the tumor board remain unclear.
2. The authors used four alternative definitions of clinical success as bilirubin decrease in this
study. However, the major aim of biliary drainage should be not only to reduce jaundice but
also to provide opportunities for antitumor therapy, avoid biliary events such as cholangitis, and
maintain quality of life (QoL). Shouldn't the appropriateness of the treatment be evaluated using
outcomes that reflect these goals?
3. Please describe the treatment content and strategies after biliary drainage for both curative
and palliative diseases. If the treatment strategies differ between the two groups after biliary
drainage, it is likely that the observation periods between the two groups will differ. Therefore,
please clarify the observation periods for both groups.
4. Differences in patient backgrounds and observation periods can impact treatment outcomes
(i.e., the longer the observation period, the higher the likelihood of increased reintervention rates
due to stent occlusion, whereas the shorter the observation period, the higher the likelihood of
underestimating the frequency of complications). Comparing treatment outcomes between these
two groups with different patient backgrounds requires careful interpretation. This should be
clearly stated as a major limitation of this study.
5. It is desirable to evaluate adverse events by dividing them into early (within 2 weeks) and
late (after 2 weeks) occurrences.
6. Please confirm the timing of the evaluation of clinical success.
7. In Table 2, the number of procedures is noted, but over what period were these procedures
performed? Are reinterventions for stent occlusion also counted? The results may vary
depending on the observation period.
assistant