Surgical Treatment of Distal Cholangiocarcinoma

Round 1

Reviewer 1 Report

> Better use the standard abbreviation dCCA and DCC for distal cholangio.

> Line 31: Lynch Syndrome in capital letters

> Line 102-103. As this is a revision, I believe it is correct to specify the path of the average patient to surgery as well. At least mentioning the possibility of an endoscopic stent in the case of jaundice and the different types of stent (covered, not covered, plastic, metallic) depending on whether or not the surgery is indicated.

> Line 103, mortality, not morality

> Line 148, abbreviations not declared

> About surgical principles. I believe that the risk of delay in chemotherapy treatment in the event of the onset of post-surgical complications is an important topic to deal with in a paragraph

> Line 240. Are periaortic and inferior mesenteric artery LNs intended as metastasis? A broader lymphadenectomy for PDAC have failed to demonstrate a survival benefit and have been associated with worsened perioperative and quality of life outcomes. Please comment on this topic. 

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

My dears,

Really well written review! Congratulations! I have only some super minor comments:

lynch with L in uppercase

2.2. Radiographic Evaluation > 2.2. Radiological Evaluation

References: when you have [1,2,3,4] please transform it in [1-4]

Best of luck and may the Force be with you!

Author Response

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Author Response File: Author Response.docx

Reviewer 3 Report

The authors have put forth a well written review of surgical intervention in distal cholangiocarcinomas. There is an extensive review of the data. It is well organized, easy to read and flows well. well done. My comments are small and minor:

1. It would be nice to have a small discussion on follow up of patients (how ofter to scan, how often to obtain CA19-9) as it is always a question asked by physicians. I summary of the literature here would be valuable.

2. While I understand this is targeting surgeons primarily, I think it would be good to briefly discuss the role of adjuvant chemotherapy and the need to refer to medical oncology as it would be part of the further treatment plan of a patient post surgery.

3. The TNM information would be easier to follow if it was in a table.

4. As well the survival data presented under prognostic factor would be easier to follow if it was in some kind of table. I had to read it a couple of times to truly understand what was written.

Author Response

Please see attachment. 

Author Response File: Author Response.docx