Title: Biliary Drainage in Palliative and Curative Intent European Patients with Hilar
Cholangiocarcinoma and malignant hilar obstruction: a retrospective single center analysis
Version: 6 Date: 02 Sep 2024
Reviewer's report:
The manuscript by Drews and colleagues addresses a topic that has a strong impact on the actual
clinical practice of patients with hilar cholangiocarcinoma.
However, the authors should clarify the following aspects:
- The study design consists in a direct comparison of patients in two different disease settings
(curative and palliative) that significantly differ in terms of clinical outcomes and survival;
therefore, this could represent a significant bias in the analysis and should be better addressed.
- The authors should point out another limitation of the study: the choice of the same TSB target
for the two different categories of patients. In clinical practice, the target of bilirubin after biliary
drainage may differ between patients eligible for surgery with curative intent and those eligible
only for palliative chemotherapy.
- In the “Materials and Methods” section, the authors state: “Given the European
recommendation and the accumulation of data in favor of metal stents in palliative pCCA, we
started using bilateral uncovered metal stents in palliative patients with poor functional status
and/or poor prognosis; these patients were not included in the analysis.”
Why did the authors not include these patients considering that European guidelines and actual
practice in Western countries recommend this approach?
- In the results section, the authors should include
• the type of chemotherapy treatment in the palliative group
• the rate of biliary events such as cholangitis and stent occlusion
Title: Biliary Drainage in Palliative and Curative Intent European Patients with Hilar
Cholangiocarcinoma and malignant hilar obstruction: a retrospective single center analysis
Version: 6 Date: 02 Sep 2024
Reviewer's report:
The manuscript by Drews and colleagues addresses a topic that has a strong impact on the actual
clinical practice of patients with hilar cholangiocarcinoma.
However, the authors should clarify the following aspects:
- The study design consists in a direct comparison of patients in two different disease settings
(curative and palliative) that significantly differ in terms of clinical outcomes and survival;
therefore, this could represent a significant bias in the analysis and should be better addressed.
- The authors should point out another limitation of the study: the choice of the same TSB target
for the two different categories of patients. In clinical practice, the target of bilirubin after biliary
drainage may differ between patients eligible for surgery with curative intent and those eligible
only for palliative chemotherapy.
- In the “Materials and Methods” section, the authors state: “Given the European
recommendation and the accumulation of data in favor of metal stents in palliative pCCA, we
started using bilateral uncovered metal stents in palliative patients with poor functional status
and/or poor prognosis; these patients were not included in the analysis.”
Why did the authors not include these patients considering that European guidelines and actual
practice in Western countries recommend this approach?
- In the results section, the authors should include
• the type of chemotherapy treatment in the palliative group
• the rate of biliary events such as cholangitis and stent occlusion
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: 6 Date: 02 Sep 2024
Reviewer's report:
The manuscript by Drews and colleagues addresses a topic that has a strong impact on the actual
clinical practice of patients with hilar cholangiocarcinoma.
However, the authors should clarify the following aspects:
- The study design consists in a direct comparison of patients in two different disease settings
(curative and palliative) that significantly differ in terms of clinical outcomes and survival;
therefore, this could represent a significant bias in the analysis and should be better addressed.
- The authors should point out another limitation of the study: the choice of the same TSB target
for the two different categories of patients. In clinical practice, the target of bilirubin after biliary
drainage may differ between patients eligible for surgery with curative intent and those eligible
only for palliative chemotherapy.
- In the “Materials and Methods” section, the authors state: “Given the European
recommendation and the accumulation of data in favor of metal stents in palliative pCCA, we
started using bilateral uncovered metal stents in palliative patients with poor functional status
and/or poor prognosis; these patients were not included in the analysis.”
Why did the authors not include these patients considering that European guidelines and actual
practice in Western countries recommend this approach?
- In the results section, the authors should include
• the type of chemotherapy treatment in the palliative group
• the rate of biliary events such as cholangitis and stent occlusion
assistant