Colorectal Cancer Liver Metastases: Is an R1 Hepatic Resection Accepted?

Round 1

Reviewer 1 Report (Previous Reviewer 1)

Tha authors has answered to all the queries as asked. I would recommend publishing the manuscript in it’s current revised form.

Author Response

Thank you very much for the kind comments and help for improving our manuscript.

Reviewer 2 Report (New Reviewer)

I found this article very interesting and productive for the scientific society. Authors have analyzed all the effect of R1 hepatic resection, the risk factors for it and the long-term survival rates. Additionally, they have included KRAS mutations with their impact on R0/R1 hepatic resection as well. However, they should consider changing the structure of the article, because all their sections (except Introduction and Discussion) end with references, instead of author's opinion.

Author Response

Response to reviewers

• As per your suggestions, the structure of the article has been changed. More specifically, at the end of each of the following sections of the article “Risk factors for R1 resection”, “Definition and prognostic implications of R1 resection”, and “Factors that could neutralize the effect of an R1 resection”, we have added the authors’ opinion.

All changes have been marked up with the “track changes” function of MS Word.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

This is an interesting review aiming to assess the association between R1 hepatic resection and CRLM.

The review is quite comprehensive, and authors have also referred to latest papers to cite their statements.

It would be great if authors could also mention and describe a few more recent reports/articles which could identifying risk factors for recurrence after hepatectomy.

This will help to determine the prognosis in CRLM after the R1 hepatic resection.

Author Response

Thank you very much for giving us the opportunity to revise and improve our manuscript according to the reviewers’ comments. We truly hope that our revise manuscript will meet the high standards of your esteemed journal for publication.

Reviewer #1

• As per your suggestion, the comment that the prognostic implications of R1 resections have not been accurately clarified yet has been appropriately rephrased in the introduction section of the revised manuscript.
• We totally agree that a systematic review is an approach of higher scientific value; however because of the wide heterogeneity of the relevant studies we designed this review in a narrative form. Our intention was to quote all the relevant literature, highlight the limitations of the existing studies and reach into conclusions cautiously. We think that the approach of presenting the timeline of the published studies and including also relatively old studies could highlight the evolution of the contemporary research questions. We believe that understanding and analyzing the way the incoming literature data have gradually reformed the current clinical practice could create the favorable conditions for further focused research on the field.
• As per your suggestion, the aspect and the prognostic implications of R1 vascular resections for colorectal cancer liver metastases have been incorporated in the discussion section of the revised manuscript.
• As per your suggestion, the reference list has been double checked and further updated in order to include the most recent literature data.
• As per your suggestion, the entire manuscript has been grammatically revised and we hope that the revised manuscript has been substantially improved in regards to the writing style and the sentence construction.

Reviewer 2 Report

The present study is a narrative review on the prognostic impact of R1 resection of colorectal liver metastasis (CRLM). The Authors state that such topic has not been accurately clarified yet, but the bulk of relevant literature on it at least partially contradict this statement. The reading is enjoyable and appealing but the quality of the content is not that high. Since the topic lacks novelty, the review should have a systematic and structured approach rather than purely narrative and descriptive. Moreover, some important aspects, such as the "R1 vascular", have been completely overseen. I would also suggest the Authors to focus more on the most recent evidences rather than spending so much time on old studies, which have only a purely narrative and historical meaning. The English writing style may be improved regarding the sentences construction.

Author Response

Thank you very much for giving us the opportunity to revise and improve our manuscript according to the reviewers’ comments. We truly hope that our revise manuscript will meet the high standards of your esteemed journal for publication.

Reviewer #2

• As per your suggestions, recent articles (Margonis et al. Br J Surg. 2018 Aug;105(9):1210-1220, Wang et al. J Surg Oncol. 2021 Sep;124(4):619-626 , Viganò et al. Ann Surg Oncol. 2016 Apr;23(4):1352-60) dealing with the identification of risk factors for recurrence following hepatectomy for colorectal cancer liver metastases have been included in the discussion section of the revised manuscript.

All changes have been marked up with the “track changes” function of MS Word.