Reviewer ’s report  
 
Title: Partial ALPPS versus Complete ALPPS for Staged Hepatec tomy  
 
Version: 1 Date: 15 Sep 2019  
 
Reviewer: Gabriele Spoletini  
 
Reviewer's report:  
 
There has been substantial improvement to the quality of the manuscript.  
Still there are minor changes which need to be addressed before proceeding to publication, as far 
as I am concerned: care must be taken regarding possible simplifications such as in Background: 
"To avoid PHLF, at least 20% of the liver must remain".  
In fact, 20% FLR is not sufficient in diseased livers and the authors should briefly specify that 20 
to 25% is needed in healthy livers, 30 -35% in diseased livers. Also, the risk of PHLF is virtually 
impossible to "avoid". Instead, it can be minimized by adopti ng certain preoperative measures 
(PVE, drainage of cholestatic parenchyma, etc.). This should also be clear in order not send 
unintended messages to the surgical community.  
A small change: indeed, Schlitt and Schnizbauer performed the first series of in s itu split 
procedures but the acronym ALPPS was created only later by the group of Clavien and so in 
Background you should better say "which was then named ALPPS".  
I would change the following sentence in Background "However, the authors' conclusions may 
not be reliable due to the low power of individual studies." as it sounds unfair against those 
authors ("not reliable" should be avoided, please replace. Similarly, "Low" power, I would say 
"limited" or similar).  
In Background please define "serious complication" when it is mentioned the first time, not the 
second time, as it is at present.  
 
Discussion and conclusions are more coherent now.  
There has been a good job of re -drafting the manuscript.  
 
Best wishes  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work incl ude the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able t o assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to asse ss the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 recei ved 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  
 
I agree to the open peer r eview policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/ ). I understand that any comments 
which I do not wish to be included in my named report can be included a s confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Partial ALPPS versus Complete ALPPS for Staged Hepatec tomy  
 
Version: 1 Date: 15 Sep 2019  
 
Reviewer: Gabriele Spoletini  
 
Reviewer's report:  
 
There has been substantial improvement to the quality of the manuscript.  
Still there are minor changes which need to be addressed before proceeding to publication, as far 
as I am concerned: care must be taken regarding possible simplifications such as in Background: 
"To avoid PHLF, at least 20% of the liver must remain".  
In fact, 20% FLR is not sufficient in diseased livers and the authors should briefly specify that 20 
to 25% is needed in healthy livers, 30 -35% in diseased livers. Also, the risk of PHLF is virtually 
impossible to "avoid". Instead, it can be minimized by adopti ng certain preoperative measures 
(PVE, drainage of cholestatic parenchyma, etc.). This should also be clear in order not send 
unintended messages to the surgical community.  
A small change: indeed, Schlitt and Schnizbauer performed the first series of in s itu split 
procedures but the acronym ALPPS was created only later by the group of Clavien and so in 
Background you should better say "which was then named ALPPS".  
I would change the following sentence in Background "However, the authors' conclusions may 
not be reliable due to the low power of individual studies." as it sounds unfair against those 
authors ("not reliable" should be avoided, please replace. Similarly, "Low" power, I would say 
"limited" or similar).  
In Background please define "serious complication" when it is mentioned the first time, not the 
second time, as it is at present.  
 
Discussion and conclusions are more coherent now.  
There has been a good job of re -drafting the manuscript.  
 
Best wishes  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work incl ude the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able t o assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to asse ss the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 recei ved 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  
 
I agree to the open peer r eview policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/ ). I understand that any comments 
which I do not wish to be included in my named report can be included a s confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Partial ALPPS versus Complete ALPPS for Staged Hepatec tomy  
 
Version: 1 Date: 15 Sep 2019  
 
Reviewer: Gabriele Spoletini  
 
Reviewer's report:  
 
There has been substantial improvement to the quality of the manuscript.  
Still there are minor changes which need to be addressed before proceeding to publication, as far 
as I am concerned: care must be taken regarding possible simplifications such as in Background: 
"To avoid PHLF, at least 20% of the liver must remain".  
In fact, 20% FLR is not sufficient in diseased livers and the authors should briefly specify that 20 
to 25% is needed in healthy livers, 30 -35% in diseased livers. Also, the risk of PHLF is virtually 
impossible to "avoid". Instead, it can be minimized by adopti ng certain preoperative measures 
(PVE, drainage of cholestatic parenchyma, etc.). This should also be clear in order not send 
unintended messages to the surgical community.  
A small change: indeed, Schlitt and Schnizbauer performed the first series of in s itu split 
procedures but the acronym ALPPS was created only later by the group of Clavien and so in 
Background you should better say "which was then named ALPPS".  
I would change the following sentence in Background "However, the authors' conclusions may 
not be reliable due to the low power of individual studies." as it sounds unfair against those 
authors ("not reliable" should be avoided, please replace. Similarly, "Low" power, I would say 
"limited" or similar).  
In Background please define "serious complication" when it is mentioned the first time, not the 
second time, as it is at present.  
 
Discussion and conclusions are more coherent now.  
There has been a good job of re -drafting the manuscript.  
 
Best wishes  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work incl ude the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able t o assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to asse ss the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 recei ved 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  
 
I agree to the open peer r eview policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/ ). I understand that any comments 
which I do not wish to be included in my named report can be included a s confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant