Assessment of Patient Expectations and Preferences Following OPHL: Results from an Evaluation Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript addresses an important and timely topic related to patient expectations and decision-making following OPHL. The Introduction and Materials and Methods sections are well structured and clearly written. However, several significant issues need to be addressed before the manuscript can be considered for publication.

• Ethical Approval- The manuscript must include full details of the Ethical Board approval (name of the Ethics Committee, the approval number, and the date). This information is essential for compliance with publication standards.

• The Results section would benefit from improved visualization. The data in Table 3 and Table 4 should be graphically represented (bar charts or plots with confidence intervals for every variable) to better illustrate the distribution and significance of the findings. Results presented in current form are hard to follow.

• Discussion Section-Discussion must be thoroughly rewritten. At present, it repeats the results without adequate interpretation. The authors should critically compare their findings with recent studies in the field, particularly those involving the Priority Scale, Decisional Conflict Scale (DCS), and Decisional Regret Scale (DRS), and there are many of them.
  Additionally, the literature review must be updated with more recent and relevant references to support the discussion and strengthen its academic depth. This point is closely linked to the need for an expanded and more analytical discussion.

• Study Limitations- The authors should clearly outline the limitations of their study, addressing potential biases, sample size constraints, and the generalizability of the findings.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

These authors retrospectively examined a cohort of patients who underwent open partial horizontal laryngectomy. The primary goal of this study was to identify the patient priorities pre-operatively. They further examined whether patients' preoperative expectations had been met. An additional goal included exploring decisional regret and patient-reported outcomes. This study adds to the literature on outcomes after head and neck cancer treatment. The writing is clear, organized, and concise. The background/literature review is appropriate and adequate. Methodology is clear, including stats. Results are clear, including tables. Discussion was thorough and thoughtful, including limitations. One comment:

1. In Table 1, the abbreviations need to be spelled out in the footnotes (e.g., ARY/arytenoids, BOT/base of tongue, CAU/?)

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

I appreciated reading this manuscript, as the research is patient-oriented, which - as authors show is not common in the oncologic population.

Another advantage is that authors used several well-defined scales, including Decisional Regret Scale, and Quality of Life or Sharp priorities scale. 

However, I believe that this manuscript may benefit with those several comments: 

It is not clear for me when the questionnaires were collected - the study group was operated on between 20 years span, but it poses a question whether patiens were being questionned in the same period of time after the surgery or rather during last follow-up visit. If the second option is valid, it raises my concern about comparability of their answers, as patients operated over 20 years ago represent selected survivors group. In my opinion it may be useful to perform an analysis stratified by postoperative interval. 

The comparator group was presumably out of scope of this research, however the interpretation of, for example, decisional regret  may be strenghtened by the gruop of patients managed by total laryngectiomy or chemoradiotherapy. 

The statistical tests which were used by authors are appropriate, but I would suggest to underline possible insufficient power due to small number of patients in the between-groups comparisons rather than no differences between the groups. 

In the discussion section I do not agree with the interpretation with decisional regret - the statement that the surgery aligned with patients expectations -  I would underline the risk of bias - including response bias, survivor bias.

The discussion currently bases on 4 references, two which are co-authored by the authors of this manuscript. Expanding the literature review may strenghten the discussion section. 

Summarizing, this manuscript after several refinements, clearer methodology and more cautious interpretation may be a meaningful piece of literature due to the patient-oriented outcome. 

Author Response

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Reviewer 4 Report

Comments and Suggestions for Authors

This is an important and well written manuscript.

It shows that partial open laryngectomy is well accepted by the patients.

I have some comments.

A reason to perform an Open Partial laryngectomy, often is to avoid total laryngectomy or radiotherapy. It is therefore strange that the authou=rs quote only literature that show similar QOL: " ..... Overall, patients treated with OPHLs generally report 68 a good quality of life, comparable to those undergoing TL or CRT, especially in areas re-69 lated to speech and swallowing [3,5,8].... " Please comment and show literature that somehow shows a better QOL after partial laryngectomy.

It is surprising that less than 10% of the patients drink alcohol. Was there a selection bias ?

In the caption for table 1: explain the OPHL types and abbreviations. Also mention the location of the tumor (glottic, supraglottic, etc)

I would add the decisional conflict and regret questionnaires in supplemental material online

In table 3, add the threshold of these scales for a pathological score, as mentioned in the literature.

The oncologic outcomes should be presented as well. Was there a relationship between voice/qol/ regret and tumor recurrence or complications .

Was there a relationship between handicaps or  qol and regret (Decisional conflict or regret)? E.G. the minority (10–20%) experiencing chronic aspiration , did they have more regret ?

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors made satisfactory revisions of the manuscript.