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Congratulations again, and thank you for your submission.
Yours,
Yoshi
Prof. Yoshinori Marunaka, M.D., Ph.D.
[# PeerJ Staff Note - this decision was reviewed and approved by Celine Gallagher, a PeerJ Section Editor covering this Section #]
Nil
Nil
Nil
Changes as per minor revision have been made. More detailed review submitted previously
Please resubmit a revised manuscript according to the reviewers' final comment:
("The equivalent labels (changed as needed for each exposure) would be helpful on the other forest plots as well (Figures 2 and 5-11)."
Yours,
Yoshi
Prof. Yoshinori Marunaka, M.D., Ph.D.
No issues
The rebuttal to conference abstracts is reasonable. Whilst this would go against the typical standards set by for example the Cochrane Collaboration, the approach is still used in many published paper and is described in sufficient details by the authors to allow readers to understand the paper and interpret appropriately.
Comments in response to my second and third major issues are well addressed and results now presented as part of this response are well in-keeping with other published data.
Findings are in-keeping with published data and form an key role in the ongoing uncertainty about cholecystectomy and CVD risk with the authors adding to the growing body of evidence pointing to a potentially protective role in gallstone cases.
My original comment about the axes for the plots has been addressed by adding a statement on Figure 3A about which side represents increased risk of CVD and which side represents decreased risk.
The equivalent labels (changed as needed for each exposure) would be helpful on the other forest plots as well (Figures 2 and 5-11).
no comment
no comment
no comment
no comment
Dear Dr. Song,
If you feel you can revise your manuscript according to the reviewers' comments, please revise your manuscript and submit it. Please also send us your written responses to each of the reviewers' comments.
Yours,
Yoshi
Prof. Yoshinori Marunaka, M.D., Ph.D.
Well written, minor typographical issues only
1. “forth” should be “fourth” in sentence 2 of introduction
Overall well conducted piece of research with sensible findings. Some minor issues on the whole.
As per comments below the major issues requiring greater discussion in paper relate to the selection of controls and how these influence findings.
No major issues
This is a systematic review and meta-analysis of the impact of cholecystectomy on CVD, CVD-mortality and all-cause mortality.
The authors find that cholecystectomy is not associated with CVD but is associated with CVD mortality and all-cause mortality (but not cancer specific mortality).
Introduction is well written. Inclusion criteria are appropriate. Search strategies are a little limited but otherwise appropriate.
Major Issues
1. Excluding conference abstracts may weaken the validity of the review as positive findings are far easier to publish than negative ones. By excluding conference papers the study authors may inadvertently weaken the review through publication bias.
2. The control groups are not clear enough in the main paper. Whether comparing cholecystectomy to gallstone-carriers or to healthy controls or a mix of both is key to determining whether cholecystectomy may have any causal effect or whether there is an association driven by gallstones as a confounder. This could be considered in subgroup analyses (CS vs GS and CS vs healthy controls).
3. Whilst this is at least partially addressed in the discussion, the discussion and conclusion should make it clearer that any association may be driven by gallstones alone and that the post-cholecystectomy population may require similar surveillance to the gallstone population. It remains possible that compared to gallstone carriers, cholecystectomy reduces risk of CVD.
Minor Issues
1. “forth” should be “fourth” in sentence 2 of introduction
2. Is there a possibility data was missed due to limited search strategies – e.g. by limiting to “cardiovascular disease” is there a possibility of missing “angina”, “ischaemic heart disease”, “myocardial infarction”, “stroke”, “coronary artery disease” etc.
3. The use of the I2 statistic and P value is a little atypical as the P value is often used for purely determining presence of heterogeneity and I2 for quantifying it. Here the authors have used a combination of tests purely for determining the presence of heterogeneity.
4. The x axis labels on Figure 4 are unreadable and blur together
5. More detail should be added to the Forest plots to make it clear which side of the reference line demonstrates increased risk of CVD with cholecystectomy and which side shows reduced risk so that they can be interpreted without reading the text
This is a systemic review and meta-analysis on cholecystectomy and the risk of cardiovascular risk, all cause and cause specific analysis. The abstract is well written, the methodology ,inclusion and exclusion criteria are clear. The results are clear and the discussion section is also well written. The language used clear and the conclusions are consistent with the evidence provided. The reference section is adequate.
My comments with this study is the definition of gallstones, as i assume that this study states that all gallstones are cholesterol in nature, and not infected or pigment stones. It might be better to state that this study is for cholesterol gallstones. As for the remaining sections of this article i have no comments.
The aim and scope of this study is well defined, The PRISMA guideline is well stated and the synthesis of the articles that were collected and screened were well done. The analysis of the 14 articles that were included in this systemic review and meta-analysis were well documented .I have no comments for this section.
The findings of this systemic review and meta-analysis is consistent with the literature presented that laparoscopic cholecystectomy is not associated with cardiovascular disease. The presentation of the forest plot and odd's ratio are robust and statistically sound. The results are consistent with the evidence that was provided. The conclusions are consistent with the evidence provided. I have no comments with this section of the article.
I would like to suggest the definition of gallstones be specified as this article deals with cholesterol stones and cardiovascular disease risk .It might be better to state it as cholesterol stones.
The article has been written in a clear and crisp manner with simple English used throughout the article. However, in line 88, a sentence is incomplete. Secondly, why only prospective studies were included. kindly also review the total number of articles initially selected and the number of articles rejected don't match.
1. Research question has been well defined. the methods used in identifying the article are well defined. The authors have done a rigorous investigation to a high degree and technical standard.
the study has been justified with use of statistics. conclusions are well stated.
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