Successful Multidisciplinary Treatment with Laparoscopic Hepatectomy and Adjuvant Therapy for Metachronous Solitary Hepatic Metastasis after Excision of a Primary Anorectal Malignant Melanoma: A Case Report

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The authors presented a very interesting case of ARMM with solitary liver metastasis. The case was well shown and the discussion was detailed. Please also summarize the significance of this clinical case, including how it brings new perspectives to the diagnostics or the theapeutics of this disease.

Comments on the Quality of English Language

Could be further polished.

Author Response

Thank you very much, for your comprehensive review. As you have suggested I have added following sentences as summary and try to elicit implication of the present case for broader population. 

"Recent advances in development of immune checkpoint inhibitors and cumulative knowledge on favorable outcomes of liver metastasectomy for solitary liver metastasis of cutaneous malignant made formulation of the novel multidisciplinary management in this case.  Our findings suggest that resection of metastasis together with adjuvant therapy with pembrolizumab maybe feasible option for patients with metachronous solitary liver metastases after surgery for a primary ARMMM.   "

Reviewer 2 Report

Comments and Suggestions for Authors

The article discusses a case of anorectal malignant melanoma (ARMM), a rare condition. While the abstract highlights a unique scenario involving a 76-year-old woman with a solitary liver metastasis after a laparoscopic abdominoperineal resection of ARMM, several negative aspects stand out.

Firstly, the rarity of ARMM is emphasized, which implies that the disease is challenging to diagnose and often detected at an advanced stage with metastases present in a significant proportion of patients. This late diagnosis contributes to the generally poor prognosis associated with ARMM.

The case presented involves a metachronous solitary liver metastasis, an exceedingly uncommon occurrence. This rarity may raise concerns about the generalizability of the findings and the applicability of the described treatment approach to a broader population.

Additionally, the abstract mentions the initiation of adjuvant therapy with pembrolizumab, but it does not provide information on the effectiveness or potential side effects of the treatment. Lack of details on treatment outcomes and potential adverse effects limits the comprehensive understanding of the patient's overall experience and the broader implications for similar cases.

Furthermore, the abstract does not discuss the potential limitations or challenges faced during the laparoscopic wedge hepatectomy or the adjuvant therapy. A more critical evaluation of the difficulties encountered or potential complications in the treatment process would have added depth to the abstract.

In summary, while the abstract provides a unique case of ARMM with a metachronous solitary liver metastasis and a novel treatment approach, it falls short in addressing the broader implications, potential limitations, and treatment outcomes. The lack of comprehensive information on these aspects diminishes the overall impact and applicability of the presented case for clinicians dealing with similar patients.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

After the revisement, the quality of this manuscript improves.