On 2015 Oct 17, Salomone Di Saverio commented:

Thanks for your reply. You have written: "They still believe fibrin sealants may be beneficial in the setting of liver surgery and they criticize our nonsignificant findings." If you read carefully our letter it was wirtten: "Although from our experience we might agree with the authors' conclusions that fibrin sealant use does not significantly influence the incidence and severity of surface-related complications after liver resection, after looking carefully at the data of the present randomized controlled trial, we have several concerns about a good balance between the 2 groups and percentages and statistical significance given in the article. The generalizability of the results may therefore be affected and the conclusions may not be strongly supported by the data." It does mean that we DO agree that fibrin sealant does NOT influence complications and therefore is NOT beneficial, but we had concerns on the good balance between the 2 groups and percentages and statistical significance in this study. Furthermore many differences between groups, although not reaching merely statistical significance, did show a clinically meaningful significance; e.g. the percentage of patients who underwent preoperative chemotherapy less than 3 months before surgery, even counting the original 20% vs 12%, is still really very close to the boundaries of statistical significance (0.059) and maybe almost double of patients between the two groups (30/154 vs 17/148) can be clinically meaningful? Having said that, we confirm once again our agreement that application of fibrin glue sealant after hepatectomy does not seem justified

On 2015 Oct 17, Salomone Di Saverio commented:

Thanks for your reply. You have written: "They still believe fibrin sealants may be beneficial in the setting of liver surgery and they criticize our nonsignificant findings." If you read carefully our letter it was wirtten: "Although from our experience we might agree with the authors' conclusions that fibrin sealant use does not significantly influence the incidence and severity of surface-related complications after liver resection, after looking carefully at the data of the present randomized controlled trial, we have several concerns about a good balance between the 2 groups and percentages and statistical significance given in the article. The generalizability of the results may therefore be affected and the conclusions may not be strongly supported by the data." It does mean that we DO agree that fibrin sealant does NOT influence complications and therefore is NOT beneficial, but we had concerns on the good balance between the 2 groups and percentages and statistical significance in this study. Furthermore many differences between groups, although not reaching merely statistical significance, did show a clinically meaningful significance; e.g. the percentage of patients who underwent preoperative chemotherapy less than 3 months before surgery, even counting the original 20% vs 12%, is still really very close to the boundaries of statistical significance (0.059) and maybe almost double of patients between the two groups (30/154 vs 17/148) can be clinically meaningful? Having said that, we confirm once again our agreement that application of fibrin glue sealant after hepatectomy does not seem justified