Chylous Ascites Associated with Advanced Pancreatic Cancer That Improved with Appropriate Treatment: A Case Report

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Imai et al. reported the clinical case of a patient with metastatic pancreatic cancer treated with first-line chemotherapy and had a partial response to the treatment. Despite the good response of the tumor to chemotherapy, the patient developed chylous ascites that led to marked anorexia and worsening of the patient’s performance status. The case is interesting considering that chylous ascites is rare in patients with pancreatic cancer. Moreover, the authors highlighted the importance of using octreotide and dietary measures in the management of chylous ascites. This case report is of interest to clinicians and it should be published.  However, moderate editing of English language is required.

Comments on the Quality of English Language

Moderate editing of English language is required.

Author Response

Response letter for reviewer 1

Thank you very much for reviewing my case report.

Responses to reviewer will be provided as below.

Reviewer 1

Imai et al. reported the clinical case of a patient with metastatic pancreatic cancer treated with first-line chemotherapy and had a partial response to the treatment. Despite the good response of the tumor to chemotherapy, the patient developed chylous ascites that led to marked anorexia and worsening of the patient’s performance status. The case is interesting considering that chylous ascites is rare in patients with pancreatic cancer. Moreover, the authors highlighted the importance of using octreotide and dietary measures in the management of chylous ascites. This case report is of interest to clinicians and it should be published.  However, moderate editing of English language is required.

(Response)

Thank you very much for reviewing our case report. The reviewer pointed out the quality of the English, so we asked the English editing company to edit our case report again.

Again, thank you very much for your peer review.

Reviewer 2 Report

Comments and Suggestions for Authors

Title: Chylous ascites associated with advanced pancreatic cancer that improved with appropriate treatment: A case report

This article describes a rare case of chylous ascites complicated by advanced pancreatic cancer and the treatment of chylous ascites.

This paper describes a relatively rare case, but there are some questions and the author is requested to add the description according to the comments as below.

Major points

1.     Tumor markers

The author should describe details of tumor markers in this case.

2.     Patient outcome

The author should describe details of the patient`s outcome after hospitalization.

Author Response

Response letter for reviewer 2

Thank you very much for reviewing my case report.

Responses to reviewer will be provided as below.

This article describes a rare case of chylous ascites complicated by advanced pancreatic cancer and the treatment of chylous ascites.

This paper describes a relatively rare case, but there are some questions and the author is requested to add the description according to the comments as below.

Major points

1. Tumor markers

The author should describe details of tumor markers in this case.

(Response)

Thank you very much for your important comment.

Tumor markers at the time of CT assessment and discharge have been added to the case presentation section. (Red font. Line 47-48, line 62, line 84)

2. Patient outcome

The author should describe details of the patient`s outcome after hospitalization.

(Response)

Thank you very much for your important advice.

In the case presentation section, details of the patient's outcome from discharge to date have been added. (Blue font. Line 56-94.)

Again, thank you very much for reviewing our case report.

Reviewer 3 Report

Comments and Suggestions for Authors

The case report is about a case of chylous ascites associated with pancreatic cancer that authors affirm to be extremely rare with only 3 cases described in literature.

I appreciated the topic and I think that the manuscript publication can be appropriate in Current Oncology journal, considering all the limit that authors correctly claimed in the text.

I appreciated figure 2 for its clarity and usefulness, good idea.

I have some minor comments:

·The sentence at lines 38-40 should be more clear in presenting the figure (1 a) as a CT image.

·At line 56 the CT scan is the third, not the second (it was figure 1b).

·Lines 103-104 write “…caused compression….” Instead “…was compression…”

·At lines 137-140 (or later) references that support the hypothesis of the cause of discrepancy between the shrinkage of cancer and progression of ascites accumulation should be introduced.

I further suggest that in this case, for the confirmation about the cause of chylous ascites, the lymphoscintigraphic study with radionuclide could be useful; authors could insert a paragraph in discussion about it (not mandatory).

Author Response

Response letter for reviewer 3

Thank you very much for reviewing my case report.

Responses to reviewer will be provided as below.

The case report is about a case of chylous ascites associated with pancreatic cancer that authors affirm to be extremely rare with only 3 cases described in literature.

I appreciated the topic and I think that the manuscript publication can be appropriate in Current Oncology journal, considering all the limit that authors correctly claimed in the text.

I appreciated figure 2 for its clarity and usefulness, good idea.

(Response)

Thank you very much for your kind comments.

I have some minor comments:

• The sentence at lines 38-40 should be more clear in presenting the figure (1 a) as a CT image.

(Response)

Thank you for your comment. We have noted that figure 1a is a CT image, as you have indicated. (Green font in case presentation section. Line 40-41))

• At line 56 the CT scan is the third, not the second (it was figure 1b).

Thank you for pointing out the error, we have corrected the 'second' to 'third'. (Green font. Line 59.)

• Lines 103-104 write “…caused compression….” Instead “…was compression…”

Thank you so much for pointing out my mistake. We have corrected the text as you have indicated. (Green font. Line 107.)

• At lines 137-140 (or later) references that support the hypothesis of the cause of discrepancy between the shrinkage of cancer and progression of ascites accumulation should be introduced.

(Response)

Thank you for your important comments. As pointed out, evidence of the discrepancy between ascites accumulation and improvement in pancreatic cancer pathology was needed. Clinical trials using ascites reduction to determine the efficacy of anticancer drugs have been added as citations. (Jpn J Clin Oncol. 204 Jun; 34(6):316-322) (Green font. Line 145-146)

I further suggest that in this case, for the confirmation about the cause of chylous ascites, the lymphoscintigraphic study with radionuclide could be useful; authors could insert a paragraph in discussion about it (not mandatory).

(Response)

Thank you so much for your important comments. We have added the sentence about the radionuclide lymphoscintigraphic study with reference. (Green font. Line 136-140.)

Again, thank you very much for your peer review.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Title: Chylous ascites associated with advanced pancreatic cancer that improved with appropriate treatment: A case report 

This paper describes a rare case of chylous ascites complicated by advanced pancreatic cancer.

The authors responded to all comments and improved the manuscript.

Author Response

Response letter for reviewer 2

Thank you for reviewing our manuscript.

We have revised the manuscript and figures according to your suggestions as follows.

(Comments)

In figure 2
"pancture" should be "puncture".
"High-calorie nutrition" should be "Intravenous high-calorie nutrition".

(Response)

Thank you very much for pointing out our mistake.

We have corrected the diagram according to your suggestion.

(Comments)
There are still some awkward English sentences.
For example, "Previous case reports reported that treatment with octreotide appeared to improved chylous ascites" should be "Previous case reports reported that treatment with octreotide appeared to improve chylous ascites".

(Response)

Thank you very much for your kind comments.

We have revised the text according to your suggestions.

We have re-edited the manuscript and made the corrections as indicated in red font in the manuscript.