Reviewer's report
Title:Assessment of Preoperative Exercise Capacity in Hepatocellular
Carcinoma Patients with Chronic Liver Injury Undergoing Hepatectomy
Version: 1Date:28 January 2013
Reviewer: Ajith Siriwardena
Reviewer's report:
This study is a single centre cohort report of the use of pre-operative
cardiopulmonary exercise testing to predict outcome in a series of patients
undergoing liver resection for hepatocellular carcinoma (HCC) complicating
chronic liver disease.
Introduction
This is well-written and clear. The sentence “In elderly patients undergoing major
abdominal surgical procedures, almost all postoperative cardiopulmonary deaths
occur in patients with an anaerobic threshold (AT) of <11 ml/min/kg” is slightly
mis-leading as cardiopulmonary deaths can occur as a result of operative
complications. Thus the sentence should be modified and simply state that the
majority of deaths from cardiopulmonary complications occur in patients with an
anaerobic threshold <11ml/min/kg.
Abstract
•There is no strong evidence that exercise therapy can modify CPET parameters
and the reference to this in the text should be removed “ Improvement of
preoperativeexercise capacity in patients with chronic liver injury may improve
postoperativePrognosis”.
Methods
•In table 1 the term NBC should be explained. There are a series of unexplained
abbreviations and there should be a table 1 legend.
•It is not clear whether the population is the 66 patients who underwent resection
or the 56 from the authors’ institution. Reading the paper, the population is really
61 patients– please clarify.
•56 patients were Child-Pugh A and 5 were B. What about the other 5 patients?
•Please provide information on the tests used to diagnose these tumours:
number undergoing MR scan and findings and also AFP levels.
•The phrase “all patients were doing well at time of discharge” is not clear and
should be more professionally expressed as “no in-patient mortality” – if that is
what the authors are trying to say.
•The section on liver resection terminology is baffling. Simply use the Brisbane
terminology; get rid of extended hepatectomy – and refer to this as right
trisectionectomy with similar for left and for smaller resections, the correct term is
non-anatomical, sub-segmental resection.
•One senior pathologist should read “one attending or consultant pathologist” –
his age and seniority are immaterial.
•If post-operative complications were not recorded prospectively, this should be
reported. If a system such as that of Dindo-Clavien was not used for assessment
of complications, this should be mentioned.
Results
•Table 3 is un-necessary and detracts from table 2 – please remove but refer to it
in the text.
•Table 5 should also be deleted and simply referred to in the text.
•The implication that exercise therapy can improve CPET is not substantiated
and should be removed.
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Reviewer's report
Title:Assessment of Preoperative Exercise Capacity in Hepatocellular
Carcinoma Patients with Chronic Liver Injury Undergoing Hepatectomy
Version: 1Date:28 January 2013
Reviewer: Ajith Siriwardena
Reviewer's report:
This study is a single centre cohort report of the use of pre-operative
cardiopulmonary exercise testing to predict outcome in a series of patients
undergoing liver resection for hepatocellular carcinoma (HCC) complicating
chronic liver disease.
Introduction
This is well-written and clear. The sentence “In elderly patients undergoing major
abdominal surgical procedures, almost all postoperative cardiopulmonary deaths
occur in patients with an anaerobic threshold (AT) of <11 ml/min/kg” is slightly
mis-leading as cardiopulmonary deaths can occur as a result of operative
complications. Thus the sentence should be modified and simply state that the
majority of deaths from cardiopulmonary complications occur in patients with an
anaerobic threshold <11ml/min/kg.
Abstract
•There is no strong evidence that exercise therapy can modify CPET parameters
and the reference to this in the text should be removed “ Improvement of
preoperativeexercise capacity in patients with chronic liver injury may improve
postoperativePrognosis”.
Methods
•In table 1 the term NBC should be explained. There are a series of unexplained
abbreviations and there should be a table 1 legend.
•It is not clear whether the population is the 66 patients who underwent resection
or the 56 from the authors’ institution. Reading the paper, the population is really
61 patients– please clarify.
•56 patients were Child-Pugh A and 5 were B. What about the other 5 patients?
•Please provide information on the tests used to diagnose these tumours:
number undergoing MR scan and findings and also AFP levels.
•The phrase “all patients were doing well at time of discharge” is not clear and
should be more professionally expressed as “no in-patient mortality” – if that is
what the authors are trying to say.
•The section on liver resection terminology is baffling. Simply use the Brisbane
terminology; get rid of extended hepatectomy – and refer to this as right
trisectionectomy with similar for left and for smaller resections, the correct term is
non-anatomical, sub-segmental resection.
•One senior pathologist should read “one attending or consultant pathologist” –
his age and seniority are immaterial.
•If post-operative complications were not recorded prospectively, this should be
reported. If a system such as that of Dindo-Clavien was not used for assessment
of complications, this should be mentioned.
Results
•Table 3 is un-necessary and detracts from table 2 – please remove but refer to it
in the text.
•Table 5 should also be deleted and simply referred to in the text.
•The implication that exercise therapy can improve CPET is not substantiated
and should be removed.
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Please review this paper.
user
Reviewer's report
Title:Assessment of Preoperative Exercise Capacity in Hepatocellular
Carcinoma Patients with Chronic Liver Injury Undergoing Hepatectomy
Version: 1Date:28 January 2013
Reviewer: Ajith Siriwardena
Reviewer's report:
This study is a single centre cohort report of the use of pre-operative
cardiopulmonary exercise testing to predict outcome in a series of patients
undergoing liver resection for hepatocellular carcinoma (HCC) complicating
chronic liver disease.
Introduction
This is well-written and clear. The sentence “In elderly patients undergoing major
abdominal surgical procedures, almost all postoperative cardiopulmonary deaths
occur in patients with an anaerobic threshold (AT) of <11 ml/min/kg” is slightly
mis-leading as cardiopulmonary deaths can occur as a result of operative
complications. Thus the sentence should be modified and simply state that the
majority of deaths from cardiopulmonary complications occur in patients with an
anaerobic threshold <11ml/min/kg.
Abstract
•There is no strong evidence that exercise therapy can modify CPET parameters
and the reference to this in the text should be removed “ Improvement of
preoperativeexercise capacity in patients with chronic liver injury may improve
postoperativePrognosis”.
Methods
•In table 1 the term NBC should be explained. There are a series of unexplained
abbreviations and there should be a table 1 legend.
•It is not clear whether the population is the 66 patients who underwent resection
or the 56 from the authors’ institution. Reading the paper, the population is really
61 patients– please clarify.
•56 patients were Child-Pugh A and 5 were B. What about the other 5 patients?
•Please provide information on the tests used to diagnose these tumours:
number undergoing MR scan and findings and also AFP levels.
•The phrase “all patients were doing well at time of discharge” is not clear and
should be more professionally expressed as “no in-patient mortality” – if that is
what the authors are trying to say.
•The section on liver resection terminology is baffling. Simply use the Brisbane
terminology; get rid of extended hepatectomy – and refer to this as right
trisectionectomy with similar for left and for smaller resections, the correct term is
non-anatomical, sub-segmental resection.
•One senior pathologist should read “one attending or consultant pathologist” –
his age and seniority are immaterial.
•If post-operative complications were not recorded prospectively, this should be
reported. If a system such as that of Dindo-Clavien was not used for assessment
of complications, this should be mentioned.
Results
•Table 3 is un-necessary and detracts from table 2 – please remove but refer to it
in the text.
•Table 5 should also be deleted and simply referred to in the text.
•The implication that exercise therapy can improve CPET is not substantiated
and should be removed.
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
assistant