PONE-D-24-13064Feasibility, safety, and efficacy of intraoperative magnetic resonance imaging-guided hepatectomy for small hepatocellular carcinoma: A retrospective studyPLOS ONE

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Additional Editor Comments:

Additional comments as Editor in response to reviewer 1's comments.

This paper examines the use of iMRI as a novel diagnostic method for small hepatocellular carcinoma and its effectiveness during open surgery. Although the novelty of the intraoperative diagnostic method is certainly present, there is concern that it is an open approach as a necessary circumstance in the current situation where MIS is widely used. However, the limitations of the indications for minimally invasive surgery have already been discussed in the limitations section.

In addition, cost-effectiveness does not need to be discussed, as it is based on existing MRI and does not significantly undermine the novelty of the present manuscript.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors present an interesting article utilizing intraoperative MRI guided hepatectomy for small HCCs and had good results doing so.

I have 2 main questions: 1) Most patients with HCC <2cm we would not perform an open hepatectomy on today in the United States. Are the authors arguing the earlier resection of HCC <2cm will lead to better outcomes? If so, what are the survival and morbidity outcomes for these patients? 2) What is the cost effectiveness of utilizing an iMRI vs. serial monitoring and f/u with imaging prior to resection once the HCC reaches a larger size? What are the survival outcomes of such as well? The authors discuss tumor free margins but no long-term outcomes

This study is obviously in comparison to pre-operative ultrasound but what about intra-operative ultrasound? We often confirm all liver lesions with intra-operative ultrasound as it is cheap and widely available at our institution.

If the HCCs are <2cm, why were these performed open vs. minimally invasive?

This project, as is, does not seem to lead to decreased cost or improved outcomes for the patients given the current study.

Reviewer #2: 1. The topic is not unique but worthy of researching

2. There are many papers in google scholar and Refseek about this topic since 2020

3. Ethical approval is mentioned

4. the title is attractive

5. The abstract is informative

6. The aim is clear

7. The KEYWORDS are good

8. Please use http://www.ncbi.nlm.nih.gov/mesh

9. Lack of the abbreviations section

10. The introduction provides sufficient background information for readers in the immediate field to understand the problem/hypotheses

11. The text arrangement is good

12. The method section is good

13. The depth of the academic material is good

14. The study design is good

15. The suitability and accuracy of questions is good

16. The research methodology is good

17. The materials are good

18. The logic is clear

19. The paper is novel

20. There are a few grammatical errors in this article

21. The related concepts are introduced

22. The readability is sufficient

23. The results are good

24. All tables are clear enough to summarize the results for presentation to the readers

25. All tables are well referred to in the text

26. Lack of figures? Please add figures.

27. The theoretical analysis in this article is sufficient

28. The discussion of results from multiple angles is sufficient

29. The conclusion is tenable

30. The reference section contains too many old references

31. Please use (google scholar and Refseek) search engines then set it since 2020

32. The references are in order within the text

33. Bias is present

34. There is no conflict of interest with the author about this topic

35. Fund is mentioned

36. Conflict of interest is mentioned

37. Acknowledgement is mentioned

38. You can use my suggestions

My final decision is acceptable after minor revision

Reviewer #3: The work presented by you is commendable and gives insight into a new modality of treatment for small HCCs of the liver. The manuscript is well written in a logical flow. The results have been written in an organized way discussion is quite relevant. Conclusion is well written.

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Reviewer #1: No

Reviewer #2: Yes: hazim alhiti

Reviewer #3: No

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Feasibility, safety, and efficacy of intraoperative magnetic resonance imaging-guided hepatectomy for small hepatocellular carcinoma: A retrospective study

PONE-D-24-13064R1

Dear Dr. Kuroda,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Takehiko Hanaki, MD, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: well-done. congratulations

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Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: Yes: hazim alhiti

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