Systematic Review and Meta-Analysis Assessing Perioperative and Oncologic Outcomes in Patients Undergoing Urologic Procedures with a History of Prior Abdominal/Pelvic Surgery: Study Protocol

Round 1

Reviewer 1 Report

I read with great interest the Manuscript titled "Protocol for a Systematic Review and Meta-Analysis Assessing  Perioperative and Oncologic Outcomes in Patients Undergoing  Urologic Procedures with a History of Prior Abdominal-pelvic  Surgery" which falls within the aim of the Journal.
In my honest opinion, the topic is interesting enough to attract the readers’ attention.
Although the manuscript can be considered already of high quality, I would suggest to take into account the following minor recommendations:
- I suggest another round of language revision, in order to correct few typos and improve readability.
-The introduction should be extended and completed. 
- Discussions can be expanded and improved by citing relevant articles about the post-surgery related morbidity .
- The authors have not adequately highlighted the strengths and limitations of their study. I suggest better specifying these points.
Considered all these points, I think it could be of interest for the readers and, in my opinion, it deserves the priority to be published after minor revisions.

Author Response

Thank you to the reviewer for making the excellent points. We have addressed them point-by-point below:

-We have thoroughly proofread the draft for typos and made corrections

-We have added context to the introduction

-Given the scope of this protocol, there is no space for an extended discussion which will be provided in the subsequent systematic review based on this protocol. However, based on your excellent suggestion, we have added greater context to outcomes related to this question in the introduction.

-We have added a discussion of the potential strengths and limitations of the study.

Reviewer 2 Report

Aim of this manuscript is to report a protocol for a systematic review and meta-analysis assessing perioperative and oncologic outcomes in patients undergoing urologic procedures with a previous history of abdominal/pelvic surgery. 

Topic is relevant and of utmost interest for the urology community.

The protocol (already registered with PROSPERO) is scientifically sound and materials and methods are clearly reported.

Author Response

Thank you for your comments and thoughtful review.

Reviewer 3 Report

This is well written protocol for a systematic review and meta-analysis assessing perioperative and oncologic outcomes in patients undergoing urologic procedures with a history of prior abdominal-pelvic surgery.

How will you graduate PAS? Did the patient have complicated or less complicated PAS? This may affect the following operations.

I would like to see the results of this study in the near future.

Author Response

Thank you for your revisions and thoughtful comments. The reviewer raises an excellent point in terms of type of PAS. Based on our preliminary analysis, there is significant heterogeneity in how PAS are reported and defined. Therefore, it makes it challenging to compare impact of PAS. This will likely be a limitation of our study, and hope to make a call to action to standardize how surgeons collect, report, and study previous surgical site insults in order to optimize surgical outcomes in the future. Our team is actively working on the definition of hostile surgical site comprising PAS with a Delphi consensus as part of the ICARUS global surgical collaboration initiative.