Minimally Invasive Surgical Approach for Esophageal Adenocarcinoma in a Patient with Previous Belsey Mark IV Fundoplication: A Case Report

Review Data

Q: Is the topic relevant to the journal area of interest? Is it contemporary and interesting for

researchers?

A: Very good

Abstract & Keywords

Q: Are all required components included in the abstract? Are the keywords appropriately chosen?

A: Excellent

Goal

Q: Is the goal explicitly stated in the Introduction? Is its formulation clear and unambiguous?

A: Good

Structure

Q: Is the paper's structure coherent? Is it in coherence with the goal of the paper?

A: Very good

Tools and Methods

Q: Are methods the author uses adequate and well used?

A: Very good

Discussion & Conclusion

Q: Is it related to the results presented before? Do you consider them as coherent?

A: Very good

Comments:

This case report describes the successful surgical management of a patient with previous thoracic anti-reflux surgery followed by Minimally Invasive Ivor-Lewis Esophagectomy (LILE), who was deemed inoperable after initial clinical staging. The case description is adequate. The report is well supported with briefly explained figures. The Discussion explains the challenges in treating the patient in the present case clearly. It also offers useful suggestions with respect to the treatment regimen. This case shows that with careful surgical dissection, there is minimal risk to the conduit such that a standard gastric conduit reconstruction can be utilized. The report finally Concludes that staging with CT-PET and EUS has a crucial role in these patients and indicate the importance of the multi-disciplinary team discussion involving specialist upper Gastrointestinal surgeons experienced in both benign (anti-reflux) and oncology surgery.

Literature

Q: Does the author utilize relevant literature?

A: Good

Author's knowledge

Q: What is the level of the author’s knowledge? Does the author utilize all recent contributions relevant to the topic?

A: Good

Length

Q: Is the length of the paper adequate to the significance of the topic? Do you suggest shortening the paper without losing its value?

A: Good

Figures & Tables

Q: Does the author use them suitably? Are legend and notations clear?

A: Very good

Writing style

Q: Is it clear and understandable?

A: Very good

Further comments on the paper

Comments: This case report presents the case of a 64-year-old male patient with a gastro-esophageal junction (GEJ) adenocarcinoma, who underwent a pediatric thoracotomy and Belsey Mark IV fundoplication, and was successfully treated by Laparoscopic Ivor-Lewis Esophagectomy (LILE). The case report holds significance as it demonstrates that these patients may still be treated with a complete laparoscopic reversal and mobilisation of a prior fundoplication wrap, without conduit compromise. The report highlights the importance of EUS as a staging modality for such cases showing invasive (T4b) disease to increase the final clinical staging accuracy.

Q: Would you recommend this manuscript for further publication?

A: Yes - Suitable to be published

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