Surgical Excision of Intramuscular Sarcomas: Description of Three Cases in Dogs

Round 1

Reviewer 1 Report

Although the manuscript is clear at what is intended to show and identify an appropriate alternative to more radical surgery and that part is interesting and worth exploring, there are many flaws.

The title is not very accurate. It says in it a comparative review but the review is only on a few papers. Additionally, the literature is old with some of the most referenced papers being between 30-40 years old now. In general I would expect more information in a literature review. At best it could be a mini review but still would need updating literature. Four papers of the literature review in veterinary medicine are clustered together and mentioned as "comparable to other studies" then these 4 papers are cited, but there is no reference as to what those papers say (they come as a bundle regarding injection site sarcoma). Even the reference in that sentence (Bray and Polton) does not seem appropriate as they used compartmental surgery but with adjuvant /neoadjuvant chemotherapy, which is not the case here.

Sometimes you imply compartmental surgery is minimally invasive (not in my opinion) sometimes you imply is major surgery. It is confusing. 

The structure on materials and methods needs major revision. That section should include much more information. In fact most of the content you included in the results section should be in the materials and methods. 

The material and methods would make more sense including data collection/case selection, diagnostic investigation, treatment. 

Then the results describing results after surgery, outcome, histopathology...etc

The histopathology information is not clear. The manuscript mentions at first how lower or intermediate grade STS do better or worse with one or another treatment but there is no grade in these cases apart from case 2 G1 after surgery.

Most importantly case 3 was diagnosed by cytology from referring vets. Had a big surgery with a suggested STS from cytology, not clear who interpreted the cytology, was a board certified pathologist? This dog had a hemangiosarcoma and died from suspected brain metastasis. This case could present ethical issues when read by other readers the way it is now as further staging would have been needed after knowing this was a hemangiosarcoma with high metastatic potential. It would need to be explained and justified so this case can be shown without ethical compromise.

Contractions need to be expanded the first time. Like VCOG-...

The figures needs some more information, what planes are being shown, indicate with arrows where the lesions are. Many readers might not have much experience reading CTs. Some are a bit blurred. I am not sure they are adequate for publication. You might be able to get better clearer images.

The citation needs to be revised as sometimes there are commas, sometimes don't, sometimes are doubled at the beginning of the sentence and then at the end repeated again. Lastly there are some references that need the hournal names to be changed into itallic.

 

Comments for author File: Comments.pdf

Author Response

Dear Editors and Referees. The authors really wish to collectively thank you for all constructive criticisms of our manuscript. We have made every attempt to address each point and we detail our answers and changes, when made, below. We hope that the end result is a stronger body of work thanks to your invaluable input. Now the paper has been deeply modified and many changes have been done in all the manuscript sections.   Please find attached the author's reply file.

Author Response File: Author Response.pdf

Reviewer 2 Report

Authors of the manuscript described surgical procedure in three dogs affected by intramuscular sarcomas with no signs  fascial invasion at imaging in which one of the dog had an intramuscular hemangiosarcoma affecting the splenius capitis muscle representing the first case of a primary muscular hemangiosarcoma removed via compartmental surgery. Methodology of the article does not raise much remarks. Weak site of this manuscript is low number of clinical cases however such clinical  description can be helpful for practicing surgeons. References are adequate. An article: "Surgical Excision of Intracompartmental (Muscular) Sarcomas:  A Comparative Review of the Literature and Description of  Three Cases in Dogs " can be publish in Animals.

Author Response

Dear Editors and Referees. The authors really wish to collectively thank you for all constructive criticisms of our manuscript. We have made every attempt to address each point and we detail our answers and changes, when made, below. We hope that the end result is a stronger body of work thanks to your invaluable input. Now the paper has been deeply modified and many changes have been done in all the manuscript sections.

Reviewer 3 Report

Comments to the Author 

             Thank you very much for your submission. It was exciting to read this manuscript, and I enjoyed reading it. It was recognized that compartmental excision is an essential concept in veterinary surgery as well. However, it is unclear what kind of cases are indicated for this procedure and how it is advantageous, so it is unclear what the authors want to tell the readers. Also, the proofreading of the sentences is difficult to understand and does not form a manuscript. Furthermore, the way references are cited is incorrect. Unfortunately, it is not suitable for submission currently. 

I have fair comments; however, these should not be viewed negatively as these are good cases, and I think some changes will contribute to this body of literature. It would help if you were more explicit about what you want to convey to your readers from these cases. Please check the submission guidelines, make corrections, and resubmit. These reports are generally limited to a limited number of cases.

Please reconsider whether the article or the case study is more appropriate. This type of report is generally limited to a limited number of cases. Please reconsider whether the article or the case study is more appropriate.

 

 

 

Title:

The title is confusing since this manuscript is considered a literature review. Please consider reconsidering the title.

 

 

Abstract:

Is the abstract a clear, concise (< 200 words), accurate representation of the study's significant findings? The abstract is about 50-60 words too long. Please see the overall manuscript comments concerns, then address the respective changes needed in the abstract.

 

 

Keywords:

Minimally invasive surgery generally indicates endoscopic surgery and interventional radiology.

 

 

Introduction:

You have described the compartment excision in detail, but it is confusing. The same information is repeated in some places, so please consider organizing it so that the intent of this manuscript will be clearer to the reader. Please also check the rules of writing and how to indicate references.

 

Line 51-53: 'Compartmental excision is based on the principle that a solid tumor that develops inside a compartment tends to grow inside, remaining confined within the fasciae which act as a barrier.'

Please provide references if possible.

 

Line 57: 'More recently…'

If you have any new references, please add them.

 

 

Materials and Methods

It is unclear what was done and how in this manuscript. Since the number of cases is limited, please consider stating that compartment excision was reviewed in three cases of intramuscular sarcoma, which would be easier to understand.

For example.

2.1 Case selection (including 3.1 clinical cases)

2.2 Surgery (including 3.2)

2.3 Postoperative care and follow-up (including 3.3)

Also, if anesthesia and pain management are common among the three cases, please consider including them in the M&M.

 

Line 153: '2.1 Case selection

If materials and methods are case selection only, consider removing this sentence. 

 

 

Results:

Consider writing about the diagnosis, surgery, and postoperative care and follow-up for each case.

 

Line 174: How should this sentence be interpreted?

 

Figures 1, 2, 3:

Consider indicating the mass with an arrow or something similar. Consider indicating the dog's orientation.

Figure 2:

Only Case 2 has a 3D image; is there something special about it?

 

Figure 3:

Line 214: 'C7' spell out.

 

Figure 4B:

Please identify what you want to show from the image in B.

 

Figure 5:

Consider indicating the dog's orientation.

Line: 269 'released from the vertebrae…'

The vertebrae cannot be seen in the photo; is this correct? It may be a spinous process.

 

Figure 6:

Are histopathology photographs necessary for this manuscript?

 

 

Discussion

Line 327-331: This sentence is the result.

 

Line 332-341: This discussion is important to this manuscript. Consider the relationship between the function of the resected muscle and postoperative function. Consider describing it in one paragraph.

 

Line 341-355: Consider discussing the CT images, including the basis for determining that the tumor is localized within the compartment.

 

Line 356-367: This paragraph is very interesting, but please clearly relate it to these cases.

 

Line 379-388: Let me ask you what you want to tell readers about drains. This content is not a discussion but the result of intraoperative decision-making.

 

Line 384: 'Only dog n. 3'

What does this mean?

 

Line 389-393: What does this paragraph want to tell the reader?

 

Line 395-397: Is this the purpose of this manuscript? The manuscript needs to be re-structured to tell this to the reader.

 

Line 398-403: This sentence is not a limitation of this manuscript. Please consider moving it elsewhere.

 

Conclusion

The conclusion should not be a common opinion but should be the conclusion of this manuscript.

 

References

Please reconfirm the submission guidelines.

 

Comments for author File: Comments.docx

Author Response

Dear Editors and Referees. The authors really wish to collectively thank you for all constructive criticisms of our manuscript. We have made every attempt to address each point and we detail our answers and changes, when made, below. We hope that the end result is a stronger body of work thanks to your invaluable input. Now the paper has been deeply modified and many changes have been done in all the manuscript sections.   Please find attached the reply letter.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Dear authors. I think the manuscript looks a lot better. There are only minor comments and edits that would need to be addressed. I believe editors will take care of those but I have edited or commented in some examples.

I think after addressing the minor edits and doing the small corrections the manuscript is good to go

Comments for author File: Comments.pdf