Early Cervical Cancer and Recurrence after Minimally Invasive Surgery without Uterine Manipulator

Round 1

Reviewer 1 Report (Previous Reviewer 1)

This study is a retrospective study that evaluated whether uterine manipulators affect oncologic outcome. It contains important information to consider appropriate case-selection and the surgical techniques for minimally invasive surgery. However, as the authors pointed out, this study has small number of cases, which couldn’t draw any conclusions. In addition, as the literatures regarding the surgical techniques, including using a uterine manipulator have been recently reported with some specific points so far, there was little novel information in this case report. Therefore, after reviewing the manuscript, the reviewer has regretfully concluded that the topic covered in surgeries-1912639 does not have a high enough quality for publication in this journal.

Reviewer 2 Report (Previous Reviewer 2)

The article can be accepted

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 study is a retrospective study that evaluated whether uterine manipulators affect oncologic outcome in the patients with cervical caner. It contains important information to consider appropriate case-selection and the surgical techniques for minimally invasive surgery. However, as the authors pointed out, this study has small number of cases, which couldn’t draw any conclusions. In addition, as the literatures regarding the surgical techniques, including using a uterine manipulator have been recently reported with some specific points so far, there was little novel information in this case report. 

Author Response

Dear Reviewer,

Thank you for your efforts, it was a pleasure and an honour to receive your comments to improve our manuscript. We highlighted the limitations of this study, it is a retrospective study, has a small number of cases, and the follow-up of the patients is only five years. However, we think that the strength of the work is represented by the fact that all the surgical operations were performed by only two surgeons and in the same hospital. Our study showed that the five-year rates of recurrence in patients treated with minimally invasive surgery are about 10%, similar to the LLAC study, and it is important to consider that also in a single centre, with a small number of patients, these data are confirmed.

Best regards

Reviewer 2 Report

D’Asta M. et al. reported a retrospective experience on the long-term oncological safety of laparoscopic treatment without the use of a uterine manipulator for patients with early-stage cervical cancer.

The issue is very interesting topic, the work is well structured and we recommend it for publication but after author’s reply to minor criticisms:

1.      The authors have not adequately highlighted the strengths and limitations of their study. Which are?

2.      What are the actual clinical implications of this study? it is important to report the results obtained by the authors in the context of clinical practice and to adequately highlight what contribution this study adds to the literature already existing on the topic and to future study perspectives

3.      Which type of uterine manipulator was used by the clinicians?

4.      These articles should be included in the discussion:

·        D'Oria O, Corrado G, Laganà AS, Chiantera V, Vizza E, Giannini A. New Advances in Cervical Cancer: From Bench to Bedside. Int J Environ Res Public Health. 2022 Jun 9;19(12):7094.

·        Ferrandina G, Corrado G, Scambia G. Minimally invasive surgery and quality of life in cervical cancer. Lancet Oncol. 2020 Jun;21(6):746-748.

·        Corrado G, Vizza E, Legge F, Pedone Anchora L, Sperduti I, Fagotti A, Mancini E, Gallotta V, Zampa A, Chiofalo B, Scambia G. Comparison of Different Surgical Approaches for Stage IB1 Cervical Cancer Patients: A Multi-institution Study and a Review of the Literature. Int J Gynecol Cancer. 2018 Jun;28(5):1020-1028.

Author Response

Dear Reviewer,

thank you for your efforts, it was a pleasure and an honour to receive your comments to improve our manuscript. We proceeded in modifying all the critical points following your suggestions and comments. 

• The authors have not adequately highlighted the strengths and limitations of their study. Which are?

We have highlighted the strengths, the limitations, and the actual clinical implications of the study in the discussion section

• What are the actual clinical implications of this study? it is important to report the results obtained by the authors in the context of clinical practice and to adequately highlight what contribution this study adds to the literature already existing on the topic and to future study perspectives

We have included these data in the discussion section

• Which type of uterine manipulator was used by the clinicians?

It was used a Clermont-Ferrand model manipulator

• These articles should be included in the discussion:

All the suggested articles were included in the discussion

We hope that now the article could be suitable for publication

Best regards