Title: Prognosis of Incompletely Resected Small Rectal Neuroendocrine Tumor using
Endoscope without Additional Treatment
Version: 2 Date: 16 Apr 2022
Reviewer's report:
THis is an interesting retrospective study  of follow up of incomplete resection of rectal NET.
It is  relatively large series.
31 cases had incomplete resection and 2 years of follow up with no additional therapy.
77 incomplete resections  in total  were part of the study. I wonder if there were reasons why the
ones that had additional resection were high risk? I dont see a comparison of  all clinical details
of those that had additional surgery to those that did not.?
Follow up was by colonoscopy but it says CT was also done- when was this done and who had
CT. DId anyone have MRI rectum which would be the best way of picking up LN? Why was
the scar not  biopsied in all cases . Surely this is the best way of picking up recurrence?
Proper muscle is not a term I am familiar with - normally this would be muscularis propria??
line 210  is  interesting. The discussion clearly indicates the follow up was  not long enough to
make  firm conclusions on whether the patient is cured, hence presumably follow-up is needed,
as per European guidelines. The conclusion therefore is that recurrence is very low in the first
two years  and that the ideal follow up interval is not known.
The conclusion  in line 210  seems to be  that small G1 rectal NET can be observed without any
additional treatment.  This may well be true  but since we dont really know if late recurrence
is going to occur in these patients, it is difficult to say that no additional therapy is definitely
not of benefit from the data presented.
The ENETS guidelines quoted from 2012  ( ref 13)are not the most recent version
A recent  publication on the topic is not referenced. DOI: 10.1111/codi.15978. O'Neill S.
Colorectal disease 2021, which indicates MRI is necessary.
I am perplexed as to why the large series by Kim 2018 is not referenced..Kim et al. BMC
Gastroenterology (2018) 18:77 https://doi.org/10.1186/s12876-018-0806-y
Title: Prognosis of Incompletely Resected Small Rectal Neuroendocrine Tumor using
Endoscope without Additional Treatment
Version: 2 Date: 16 Apr 2022
Reviewer's report:
THis is an interesting retrospective study  of follow up of incomplete resection of rectal NET.
It is  relatively large series.
31 cases had incomplete resection and 2 years of follow up with no additional therapy.
77 incomplete resections  in total  were part of the study. I wonder if there were reasons why the
ones that had additional resection were high risk? I dont see a comparison of  all clinical details
of those that had additional surgery to those that did not.?
Follow up was by colonoscopy but it says CT was also done- when was this done and who had
CT. DId anyone have MRI rectum which would be the best way of picking up LN? Why was
the scar not  biopsied in all cases . Surely this is the best way of picking up recurrence?
Proper muscle is not a term I am familiar with - normally this would be muscularis propria??
line 210  is  interesting. The discussion clearly indicates the follow up was  not long enough to
make  firm conclusions on whether the patient is cured, hence presumably follow-up is needed,
as per European guidelines. The conclusion therefore is that recurrence is very low in the first
two years  and that the ideal follow up interval is not known.
The conclusion  in line 210  seems to be  that small G1 rectal NET can be observed without any
additional treatment.  This may well be true  but since we dont really know if late recurrence
is going to occur in these patients, it is difficult to say that no additional therapy is definitely
not of benefit from the data presented.
The ENETS guidelines quoted from 2012  ( ref 13)are not the most recent version
A recent  publication on the topic is not referenced. DOI: 10.1111/codi.15978. O'Neill S.
Colorectal disease 2021, which indicates MRI is necessary.
I am perplexed as to why the large series by Kim 2018 is not referenced..Kim et al. BMC
Gastroenterology (2018) 18:77 https://doi.org/10.1186/s12876-018-0806-y
Please review this paper.
user
Title: Prognosis of Incompletely Resected Small Rectal Neuroendocrine Tumor using
Endoscope without Additional Treatment
Version: 2 Date: 16 Apr 2022
Reviewer's report:
THis is an interesting retrospective study  of follow up of incomplete resection of rectal NET.
It is  relatively large series.
31 cases had incomplete resection and 2 years of follow up with no additional therapy.
77 incomplete resections  in total  were part of the study. I wonder if there were reasons why the
ones that had additional resection were high risk? I dont see a comparison of  all clinical details
of those that had additional surgery to those that did not.?
Follow up was by colonoscopy but it says CT was also done- when was this done and who had
CT. DId anyone have MRI rectum which would be the best way of picking up LN? Why was
the scar not  biopsied in all cases . Surely this is the best way of picking up recurrence?
Proper muscle is not a term I am familiar with - normally this would be muscularis propria??
line 210  is  interesting. The discussion clearly indicates the follow up was  not long enough to
make  firm conclusions on whether the patient is cured, hence presumably follow-up is needed,
as per European guidelines. The conclusion therefore is that recurrence is very low in the first
two years  and that the ideal follow up interval is not known.
The conclusion  in line 210  seems to be  that small G1 rectal NET can be observed without any
additional treatment.  This may well be true  but since we dont really know if late recurrence
is going to occur in these patients, it is difficult to say that no additional therapy is definitely
not of benefit from the data presented.
The ENETS guidelines quoted from 2012  ( ref 13)are not the most recent version
A recent  publication on the topic is not referenced. DOI: 10.1111/codi.15978. O'Neill S.
Colorectal disease 2021, which indicates MRI is necessary.
I am perplexed as to why the large series by Kim 2018 is not referenced..Kim et al. BMC
Gastroenterology (2018) 18:77 https://doi.org/10.1186/s12876-018-0806-y
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