Reviewer's report
Title:Excessive Intraoperative Blood Loss Independently Predicts Recurrence of
Hepatocellular Carcinoma after Liver Transplantation
Version:2Date:10 March 2015
Reviewer: Nicholas Onaca
Reviewer's report:
This is an interesting study which shows a correlation of blood loss at surgery
with hepatocellular carcinoma (HCC) disease free survival after liver
transplantation.
Although the study is retrospective, data is robust and data analysis is
appropriate.
Most of the patients (61%) have advanced HCC at the time of transplant, being
beyond the Milan criteria.
Of note, operation time was found to be related to increased intraoperative blood
loss and labeled as a risk factor. Practically speaking, the correlation is the other
way: having more blood loss correlates with longer operative time.
The paper concludes that increased blood loss is associated with lower disease
free survival. The data, however, shows that this is applicable mostly for tumors
exceeding Milan criteria, whereas the correlation is not found for tumors within
Milan criteria.
Higher intraoperative blood loss is a composite factor which reflects worse
patient physiology in combination with technical difficulties. It alsoreflects more
manipulation of the liver at the time of hepatectomy, which is possibly reflected in
more tumor shed at that time (should be part of the discussion).
The authors use disease-free survival as their endpoint. The title states that
blood loss predicts recurrence rate. In order to sustain the statement in the title,
the authors should provide tumor recurrence data (e.g. Kaplan Meier curves
using recurrence as an endpoint).
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests with regards to this paper.
Reviewer's report
Title:Excessive Intraoperative Blood Loss Independently Predicts Recurrence of
Hepatocellular Carcinoma after Liver Transplantation
Version:2Date:10 March 2015
Reviewer: Nicholas Onaca
Reviewer's report:
This is an interesting study which shows a correlation of blood loss at surgery
with hepatocellular carcinoma (HCC) disease free survival after liver
transplantation.
Although the study is retrospective, data is robust and data analysis is
appropriate.
Most of the patients (61%) have advanced HCC at the time of transplant, being
beyond the Milan criteria.
Of note, operation time was found to be related to increased intraoperative blood
loss and labeled as a risk factor. Practically speaking, the correlation is the other
way: having more blood loss correlates with longer operative time.
The paper concludes that increased blood loss is associated with lower disease
free survival. The data, however, shows that this is applicable mostly for tumors
exceeding Milan criteria, whereas the correlation is not found for tumors within
Milan criteria.
Higher intraoperative blood loss is a composite factor which reflects worse
patient physiology in combination with technical difficulties. It alsoreflects more
manipulation of the liver at the time of hepatectomy, which is possibly reflected in
more tumor shed at that time (should be part of the discussion).
The authors use disease-free survival as their endpoint. The title states that
blood loss predicts recurrence rate. In order to sustain the statement in the title,
the authors should provide tumor recurrence data (e.g. Kaplan Meier curves
using recurrence as an endpoint).
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests with regards to this paper.
Please review this paper.
user
Reviewer's report
Title:Excessive Intraoperative Blood Loss Independently Predicts Recurrence of
Hepatocellular Carcinoma after Liver Transplantation
Version:2Date:10 March 2015
Reviewer: Nicholas Onaca
Reviewer's report:
This is an interesting study which shows a correlation of blood loss at surgery
with hepatocellular carcinoma (HCC) disease free survival after liver
transplantation.
Although the study is retrospective, data is robust and data analysis is
appropriate.
Most of the patients (61%) have advanced HCC at the time of transplant, being
beyond the Milan criteria.
Of note, operation time was found to be related to increased intraoperative blood
loss and labeled as a risk factor. Practically speaking, the correlation is the other
way: having more blood loss correlates with longer operative time.
The paper concludes that increased blood loss is associated with lower disease
free survival. The data, however, shows that this is applicable mostly for tumors
exceeding Milan criteria, whereas the correlation is not found for tumors within
Milan criteria.
Higher intraoperative blood loss is a composite factor which reflects worse
patient physiology in combination with technical difficulties. It alsoreflects more
manipulation of the liver at the time of hepatectomy, which is possibly reflected in
more tumor shed at that time (should be part of the discussion).
The authors use disease-free survival as their endpoint. The title states that
blood loss predicts recurrence rate. In order to sustain the statement in the title,
the authors should provide tumor recurrence data (e.g. Kaplan Meier curves
using recurrence as an endpoint).
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests with regards to this paper.
assistant