Extra-Pleural Pneumonectomy (EPP) in Children and Adults with Locally Advanced Sarcoma: A CanSaRCC Study
, Marcelo Cypel 3, Laura Donahoe 3, Derek S. Tsang 4, John Cho 4, Marc De Perrot 3, Thomas K. Waddell 3 and Abha A. Gupta 1,5,*
Round 1
Reviewer 1 Report
The manuscript by Rodrigues and colleagues represents a monocentric experience of Extra-pleural pneumonectomy for patients with sarcoma. The authors performed a retrospective analysis of 10 patients with advanced sarcoma affecting the pleura who underwent Extra-pleural pneumonectomy between 2009 and 2021. The authors retrospectively reviewed the surgical outcomes and survival data.
Major questions/Concerns:
1- Extra-pleural pneumonectomy is a major surgical intervention and to assess the safety and feasibility of this procedure I suggest using a postoperative classification system like the Clavien-Dindo classification.
2- Including patients with primary sarcoma and patients with recurrence affect the power of this study, as we are comparing two different issues. What was the definition of recurrence? Local recurrence or lung / pleural metastases.
3- What was the definition of advanced sarcoma of pleura? Was this direct invasion of pleura or pleura metastases? In case of two entities please consider comparing the 2 groups.
4- Was the survival better in patients with relative chemo-sensitive histologies ?
5- What was the lymph node status among the patients?
Author Response
see attached file
Author Response File: 
Author Response.pdf
Reviewer 2 Report
This is a small but important subgroup of patients who receive aggressive local therapy for sarcoma. In the results section it would be helpful to group patients into chemosensitive histologies (or pediatric type sarcomas - EWS, RMS, PBB) versus other as it seems from my review that outcomes are different. I would add a bit more to the discussion emphasising the role of the multi-disciplinary tumour conference for these patients. Are there reasons that patients with recurrent disease were selected (young patient, chemo sensitive histology, long DFI etc) - that may be good to include in these reasons/rationale in the results if possible/available.
Author Response
see attached file
Author Response File: Author Response.pdf
Reviewer 3 Report
The authors described Extra-Pleural Pneumonectomy (EPP) in patients with locally advanced sarcoma. The topic is interesting and important. Please see my comments. The large limitation in this study was the number of the patients and criteria of this procedure.
1) The criteria of this surgery should be very important. Even if the decision is made by MDT team, some criteria should be there.
2) I think adenosarcoma and pleuropulmonary blastoma are not soft tissue sarcomas.
3) The authors concluded the treatment was safe and feasible. But except for 2 patients (Case3 and 5), the follow-up duration is relatively short.
4) How about the function of the respiratory after surgery?
Author Response
see attached file
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Dear Authors,
Thanks for your response. Please add the lymph node status at time of EPP to the manuscript.
sincerely,
Author Response
LN status has been added to manuscript as suggested.
My apologies for this oversight.
Reviewer 3 Report
Sorry. Several concerns have still remained. I can not recommend the publication.
Author Response
Dear reviewer, please let me know what specific concerns remain unresolved and I will do my best to address them.
