Reviewer’s report
Title: 
Salvage Liver Transplantation After Resection of Colorectal Cancer Liver
Metastasis With Favorable Outcomes; A Case Report And Review of literature
Version: 
1 
Date: 
15 Feb 2021
Reviewer's report:
I appreciate the editing of the manuscript by the Authors.
Still some points remain unclear. 
In Abstract: 
- "who underwent resection of left colon cancer and was found to have liver
metastasis" does not clarify whether he had synchronous or metachronous
disease. Please state which one of the two.
- "We reviewed the literature and some of these studies in this article and
compared their outcomes". The sentence sounds awkward and should be
rephrased. In addition, it'd be useful to briefly mention what is the state of the
literature in regards of salvage LT after POLF in patients resected for CRLMs,
otherwise it's pointless to say so in the abstract.
In main text: further refinements in English language editing are still necessary.
E.g.: 
- in main text, background: "treated in generally" should be "generally (or more
commonly) treated"; 
- in case presentation: " CT chest abdomen pelvic" should be "pelvis"; 
- "was done back then" is very informal and should be rephrased;
These are only a few examples while the whole manuscript needs further
changes.
The sequence of events should be better detailed: the patient presented with
synchronous disease, for what I understand: please specify why he had colon
resection instead of chemotherapy first, as it is more often the case nowadays in
synchronous disease. Authors can also emphasize that the first part of the
patient's management happened in a different center. Please also explain the
reason for the stoma in a chemorad-naive left hemicolectomy. 
The Authors state that there were three lesions, one of which iwas in seg4a
(which obviously falls within the left hemiliver), therefore the operation must
have comprised a deviation inside the left hemiliver to have that met excised.
Please detail the operation to explain how this lesion was treated. 
To persuade the readers about the decision to perform a right hepatectomy, some
more iconography should be presented, as I suggested in my previous review.
Reconsider the following sentence: "To decrease the risk of having positive
margin in the right portal vein preserved and with the fact that the preoperative
liver function tests were completely normal, and the future liver remanent
volume by CT volumetry was more than 50%, a decision was made to proceed
with Right hepatectomy". I understand the sense however this sentence sounds
awkward and should be revised. NB: remanent should be remnant. 
The impression of the Authors is that the pt developed POLF due to the
background chemo-induced liver damage. As the pt received 12 cycles of
oxaliplatin, a comment on the aspect of the liver on the preop CT and about the
macroscopic appearance during the operation (sinusoidal obstruction syndrome?)
should be made.
In the discussion, 
the Authors correctly mention the most important clinical
experience around LT for unresectable CRLMs. It'd be useful to provide more
details about the number and the outcome of cases performed for POLF in
CRLMs pts (expanding the existing paragraph towards the end of the discussion
section).
Limitations of the current case report should be mentioned: short interval of time
between surgery of the primary and LT, acute setting in which the LT was
performed, underestimation of the quality of the background liver when the
decision for an upfront rt hepatectomy was made (instead, the option of a
resection in two stages could be considered: ALPPS or PVL with seg4a
clearance and subsequent rt hepatectomy). I believe that only highlighting these
aspects this case report can add something to the existing knowledge.
Publons Reviewer Recognition
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review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
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profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
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Yes
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 financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that 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.
I declare that I have no competing interests
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Salvage Liver Transplantation After Resection of Colorectal Cancer Liver
Metastasis With Favorable Outcomes; A Case Report And Review of literature
Version: 
1 
Date: 
15 Feb 2021
Reviewer's report:
I appreciate the editing of the manuscript by the Authors.
Still some points remain unclear. 
In Abstract: 
- "who underwent resection of left colon cancer and was found to have liver
metastasis" does not clarify whether he had synchronous or metachronous
disease. Please state which one of the two.
- "We reviewed the literature and some of these studies in this article and
compared their outcomes". The sentence sounds awkward and should be
rephrased. In addition, it'd be useful to briefly mention what is the state of the
literature in regards of salvage LT after POLF in patients resected for CRLMs,
otherwise it's pointless to say so in the abstract.
In main text: further refinements in English language editing are still necessary.
E.g.: 
- in main text, background: "treated in generally" should be "generally (or more
commonly) treated"; 
- in case presentation: " CT chest abdomen pelvic" should be "pelvis"; 
- "was done back then" is very informal and should be rephrased;
These are only a few examples while the whole manuscript needs further
changes.
The sequence of events should be better detailed: the patient presented with
synchronous disease, for what I understand: please specify why he had colon
resection instead of chemotherapy first, as it is more often the case nowadays in
synchronous disease. Authors can also emphasize that the first part of the
patient's management happened in a different center. Please also explain the
reason for the stoma in a chemorad-naive left hemicolectomy. 
The Authors state that there were three lesions, one of which iwas in seg4a
(which obviously falls within the left hemiliver), therefore the operation must
have comprised a deviation inside the left hemiliver to have that met excised.
Please detail the operation to explain how this lesion was treated. 
To persuade the readers about the decision to perform a right hepatectomy, some
more iconography should be presented, as I suggested in my previous review.
Reconsider the following sentence: "To decrease the risk of having positive
margin in the right portal vein preserved and with the fact that the preoperative
liver function tests were completely normal, and the future liver remanent
volume by CT volumetry was more than 50%, a decision was made to proceed
with Right hepatectomy". I understand the sense however this sentence sounds
awkward and should be revised. NB: remanent should be remnant. 
The impression of the Authors is that the pt developed POLF due to the
background chemo-induced liver damage. As the pt received 12 cycles of
oxaliplatin, a comment on the aspect of the liver on the preop CT and about the
macroscopic appearance during the operation (sinusoidal obstruction syndrome?)
should be made.
In the discussion, 
the Authors correctly mention the most important clinical
experience around LT for unresectable CRLMs. It'd be useful to provide more
details about the number and the outcome of cases performed for POLF in
CRLMs pts (expanding the existing paragraph towards the end of the discussion
section).
Limitations of the current case report should be mentioned: short interval of time
between surgery of the primary and LT, acute setting in which the LT was
performed, underestimation of the quality of the background liver when the
decision for an upfront rt hepatectomy was made (instead, the option of a
resection in two stages could be considered: ALPPS or PVL with seg4a
clearance and subsequent rt hepatectomy). I believe that only highlighting these
aspects this case report can add something to the existing knowledge.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
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 financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that 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.
I declare that I have no competing interests
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Salvage Liver Transplantation After Resection of Colorectal Cancer Liver
Metastasis With Favorable Outcomes; A Case Report And Review of literature
Version: 
1 
Date: 
15 Feb 2021
Reviewer's report:
I appreciate the editing of the manuscript by the Authors.
Still some points remain unclear. 
In Abstract: 
- "who underwent resection of left colon cancer and was found to have liver
metastasis" does not clarify whether he had synchronous or metachronous
disease. Please state which one of the two.
- "We reviewed the literature and some of these studies in this article and
compared their outcomes". The sentence sounds awkward and should be
rephrased. In addition, it'd be useful to briefly mention what is the state of the
literature in regards of salvage LT after POLF in patients resected for CRLMs,
otherwise it's pointless to say so in the abstract.
In main text: further refinements in English language editing are still necessary.
E.g.: 
- in main text, background: "treated in generally" should be "generally (or more
commonly) treated"; 
- in case presentation: " CT chest abdomen pelvic" should be "pelvis"; 
- "was done back then" is very informal and should be rephrased;
These are only a few examples while the whole manuscript needs further
changes.
The sequence of events should be better detailed: the patient presented with
synchronous disease, for what I understand: please specify why he had colon
resection instead of chemotherapy first, as it is more often the case nowadays in
synchronous disease. Authors can also emphasize that the first part of the
patient's management happened in a different center. Please also explain the
reason for the stoma in a chemorad-naive left hemicolectomy. 
The Authors state that there were three lesions, one of which iwas in seg4a
(which obviously falls within the left hemiliver), therefore the operation must
have comprised a deviation inside the left hemiliver to have that met excised.
Please detail the operation to explain how this lesion was treated. 
To persuade the readers about the decision to perform a right hepatectomy, some
more iconography should be presented, as I suggested in my previous review.
Reconsider the following sentence: "To decrease the risk of having positive
margin in the right portal vein preserved and with the fact that the preoperative
liver function tests were completely normal, and the future liver remanent
volume by CT volumetry was more than 50%, a decision was made to proceed
with Right hepatectomy". I understand the sense however this sentence sounds
awkward and should be revised. NB: remanent should be remnant. 
The impression of the Authors is that the pt developed POLF due to the
background chemo-induced liver damage. As the pt received 12 cycles of
oxaliplatin, a comment on the aspect of the liver on the preop CT and about the
macroscopic appearance during the operation (sinusoidal obstruction syndrome?)
should be made.
In the discussion, 
the Authors correctly mention the most important clinical
experience around LT for unresectable CRLMs. It'd be useful to provide more
details about the number and the outcome of cases performed for POLF in
CRLMs pts (expanding the existing paragraph towards the end of the discussion
section).
Limitations of the current case report should be mentioned: short interval of time
between surgery of the primary and LT, acute setting in which the LT was
performed, underestimation of the quality of the background liver when the
decision for an upfront rt hepatectomy was made (instead, the option of a
resection in two stages could be considered: ALPPS or PVL with seg4a
clearance and subsequent rt hepatectomy). I believe that only highlighting these
aspects this case report can add something to the existing knowledge.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
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 financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that 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.
I declare that I have no competing interests
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant