Organ-Sparing Surgery for Testicular Germ Cell Tumors: A Current Perspective

Round 1

Reviewer 1 Report

Dear Authors,

 

I read with interest your narrative review on the actual role of testis-sparing surgery.

 

In my opinion, the manuscript is well written with clear key-point tables and adds some useful information in the panorama of this underdone surgery.

 

I do not find any major limitation.

 

Please try your best citing one or more of the following related papers:

·      Minerva Urology and Nephrology 2021 August;73(4):431-41. Oncological and functional outcomes of testis sparing surgery in small testicular mass: a systematic review. Vincenzo FAVILLA, Rossella CANNARELLA *, Antonio TUMMINARO, Davide DI MAURO, Rosita A. CONDORELLI, Sandro LA VIGNERA, Vincenzo FICARRA, Sebastiano CIMINO, Aldo E. CALOGERO

·      Minerva Urology and Nephrology 2022 February;74(1):72-6. The timing of initial imaging in testicular cancer: impact on radiological findings and clinical decision making. Robert DOTZAUER *, Arash SALAMAT, Nikita D. NABAR, Anita THOMAS, Katharina BÖHM, Maximilian P. BRANDT, René MAGER, Hendrik BORGMANN, Martin KUROSCH, Thomas HOEFNER, Igor TSAUR, Andreas M. HÖTKER, Axel HAFERKAMP, Wolfgang JÄGER

Author Response

Dear Reviewer,

Thank you very much for your constructive feedback and kind words about our manuscript. We appreciate your suggestion to include the suggested references in our narrative review.

We acknowledge the importance of the articles you have highlighted.

We agree that both references will enrich our manuscript and provide a more robust understanding of the current role of testis-sparing surgery. Consequently, we will incorporate these references in our review.

Thank you again for your valuable suggestions.

Reviewer 2 Report

Well designed review but low value as its narrative purpose. No sistematic methodology was used.

lit could be relevant add systematic review results.

however the topic is not so treated in literature and this work can help to better understand the knowledge on this field.

you have to add discussion about effect of radiotherapy (complications and functional outcomes) as it is mandatory in many.cases.

Can you add indications or recommendations  from other guidelines ?(aua- nice etc if present on this topic)

 

have you find any work about location, ultrasonographic features and growth pattern (eso/endophytic) as other possible factors in patient selection

 

finally

no findings on qoLife effect of this approach?

Author Response

Dear Reviewer,

We sincerely appreciate your valuable feedback on our manuscript and we are grateful for the suggestions provided to enhance its quality.

In response to your comments, we have incorporated a new paragraph towards the end of the article to highlight the limitations of our narrative review, acknowledging the absence of a systematic methodology. We believe that this adds transparency and rigor to our review.

As recommended, we have included a discussion on the effects of radiotherapy, addressing both complications and functional outcomes. This discussion has been integrated into the main body of the text to provide a more comprehensive overview of treatment options.

We've also enriched the guidelines section by incorporating the recommendations from the American Urological Association (AUA). This amendment, we hope, broadens the perspective and relevance of our review.

In terms of factors such as tumor location and growth pattern, unfortunately, our literature search did not yield substantial evidence to discuss these in detail. The quality of life (QoL) outcomes with this approach was also minimally reported in the existing literature, which is why it was not initially included in our review.

We have sought to address each of your points and hope that these modifications have improved the depth and breadth of our manuscript, while maintaining the original intent of providing a valuable synthesis of the current knowledge in this field.

Thank you once again for your critical and constructive review.

Reviewer 3 Report

The authors reviewed surgical indications, surgical techniques, complications, oncologic outcomes, and functional outcomes in testis-sparing surgery (TSS).

 

As a limitation, TSS has limited indications for testicular tumors and lacks sufficient evidence. However, several articles describe surgical indications, surgical complications, oncological outcomes, and functional outcomes during a certain observation period, and I believe these are worthy of reference.

 

The authors generally adequately described with appropriate citations to the literature, but needs some revision as follows:

 

Minor points:

#1. In the "Surgical technique" section of the Results, the data of Dr. De Stefani et al. are presented (Page 4, line 33-40), but no citation is given. I think it is perhaps reference No. 24, so please clarify the citation.

#2. Please complete the "Author Contributions" as it is incomplete.

Author Response

Dear Reviewer,

Thank you for your constructive feedback .

Regarding your minor points:

#1. You are correct in observing that the data from Dr. De Stefani et al. were presented without a citation in the "Surgical technique" section. We appreciate your attentiveness and have now added the correct citation (reference No. 25) to this section.

#2. We apologize for the incomplete "Author Contributions" section. This oversight has now been rectified, and the section fully completed.

Your careful review and insightful comments are highly appreciated and have significantly improved the quality of our work.

 

Round 2

Reviewer 2 Report

Thank you for reviewing your work and add suggested details.