Title: Inside stent placement is suitable for preoperative biliary drainage in patients with
perihilar cholangiocarcinoma
Version: 3 Date: 09 Nov 2023
Reviewer's report:
The authors reported the efficacy of IS to prevent preoperative cholangitis or other factors
in patients with perihilar cholangiocarcinoma, compared to the conventional stent (ENBD).
Although the n number was small, it showed a statistically significant difference and the
usefulness was well conveyed.
Comments are as follows:
Major
1. Prognosis such as OS, RFS, DFS, etc. in the IS and CS groups should be presented.
2. I understand that there is a difference in preoperative hospital stay and cost, but why is
there a difference in the postoperative period or cost? There was no difference in postoperative
complications. Please present your discussion, including appropriate references.
3. The main concern of this study is that there have been multiple reports in the past that IS was
superior. There is no indication of this study's superiority or novelty over other reports.
4. Please compile a table of papers comparing IS and CS to date and do a literature review. Then,
please summarize the problems of IS and CS.
5. The purpose of the study in Background is to compare the usefulness of CS and IS, but the
overall tone of the paper involves NAC. There is a slight dissociation between the objective and
the results/conclusions, and the focus is not clear. If the focus is on the usefulness of IS in NAC,
the paper should be written only in NAC cases.
Minor
1. In the ethics, the authors described “In this retrospective study, the Ethics Committee approved
that informed consent for each patient was not required”. Is this replaced by an opt-out? If so,
please describe.
2. NAC for hilar cholangiocarcinoma has not been approved in Japan, and if it is being done,
it is a clinical trial.
3. Please mention that it is registered in UMIN or other registry and the registration number.
Title: Inside stent placement is suitable for preoperative biliary drainage in patients with
perihilar cholangiocarcinoma
Version: 3 Date: 09 Nov 2023
Reviewer's report:
The authors reported the efficacy of IS to prevent preoperative cholangitis or other factors
in patients with perihilar cholangiocarcinoma, compared to the conventional stent (ENBD).
Although the n number was small, it showed a statistically significant difference and the
usefulness was well conveyed.
Comments are as follows:
Major
1. Prognosis such as OS, RFS, DFS, etc. in the IS and CS groups should be presented.
2. I understand that there is a difference in preoperative hospital stay and cost, but why is
there a difference in the postoperative period or cost? There was no difference in postoperative
complications. Please present your discussion, including appropriate references.
3. The main concern of this study is that there have been multiple reports in the past that IS was
superior. There is no indication of this study's superiority or novelty over other reports.
4. Please compile a table of papers comparing IS and CS to date and do a literature review. Then,
please summarize the problems of IS and CS.
5. The purpose of the study in Background is to compare the usefulness of CS and IS, but the
overall tone of the paper involves NAC. There is a slight dissociation between the objective and
the results/conclusions, and the focus is not clear. If the focus is on the usefulness of IS in NAC,
the paper should be written only in NAC cases.
Minor
1. In the ethics, the authors described “In this retrospective study, the Ethics Committee approved
that informed consent for each patient was not required”. Is this replaced by an opt-out? If so,
please describe.
2. NAC for hilar cholangiocarcinoma has not been approved in Japan, and if it is being done,
it is a clinical trial.
3. Please mention that it is registered in UMIN or other registry and the registration number.
Please review this paper.
user
Title: Inside stent placement is suitable for preoperative biliary drainage in patients with
perihilar cholangiocarcinoma
Version: 3 Date: 09 Nov 2023
Reviewer's report:
The authors reported the efficacy of IS to prevent preoperative cholangitis or other factors
in patients with perihilar cholangiocarcinoma, compared to the conventional stent (ENBD).
Although the n number was small, it showed a statistically significant difference and the
usefulness was well conveyed.
Comments are as follows:
Major
1. Prognosis such as OS, RFS, DFS, etc. in the IS and CS groups should be presented.
2. I understand that there is a difference in preoperative hospital stay and cost, but why is
there a difference in the postoperative period or cost? There was no difference in postoperative
complications. Please present your discussion, including appropriate references.
3. The main concern of this study is that there have been multiple reports in the past that IS was
superior. There is no indication of this study's superiority or novelty over other reports.
4. Please compile a table of papers comparing IS and CS to date and do a literature review. Then,
please summarize the problems of IS and CS.
5. The purpose of the study in Background is to compare the usefulness of CS and IS, but the
overall tone of the paper involves NAC. There is a slight dissociation between the objective and
the results/conclusions, and the focus is not clear. If the focus is on the usefulness of IS in NAC,
the paper should be written only in NAC cases.
Minor
1. In the ethics, the authors described “In this retrospective study, the Ethics Committee approved
that informed consent for each patient was not required”. Is this replaced by an opt-out? If so,
please describe.
2. NAC for hilar cholangiocarcinoma has not been approved in Japan, and if it is being done,
it is a clinical trial.
3. Please mention that it is registered in UMIN or other registry and the registration number.
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