Title: Long term persistence and risk factors for anorectal symptoms following low anterior
resection for rectal cancer
Version: 2 Date: 01 Oct 2023
Reviewer's report:
Well written paper evaluating anorectal function (AF) in patients undergoing Low Anterior
Resection (LAR) with defunctioning stoma (DS) for cancer.
An important subject that help understanding the impact of rectal resection and constructing an
anastomosis of anal canal with the sigmoid colon at the level of pelvic floor.  It is a well-known
phenomenon and generally called Low Anterior Resection Syndrome (LARS).
I comment each part separately to give as distinct feedback as possible.
Title
I suggest that the title indicate somehow that the paper even evaluates the impact of DS on AF.
Abstract
I suggest the use of LAR instead of sphincter preserving surgery due to the last mentioned term
dos not strictly indicate, total mesorectal excision (TME) while LAR does, an important detail
that partially explains the poor AF outcomes after surgery.
The term severe LARS is unnecessary because the LARS Score already has categorized LARS
to 3 categories no-LARS, minor-LARS and major-LARS. Terms that should be used throughout
the paper instead of severe or mild LARS.
Introduction
Some spelling correction The R is missing in Rectal second line.
Some repetitive segments in first paragraph “decrease of the need for abdominoperineal
resection with colostomy”
Suggest additional references when indicated LARS and quality of life, second paragraph.
It should be risk for recurrence and not chance of recurrence when mentioning the role of
adjuvant chemotherapy and risk for major-LARS.
Design
The paper is a population based prospective design in my opinion due to the intervention in this
study is done prospectively (the questionnaires) even if it has a retrospective part.
Method
It should stay if the LARS score is validated to Hebrew language in Israel with references.
Results
The reason for late stoma reversal should be mentioned and discussed as a possible explanation
for poor AF outcome. If the late reversal is due to low priority or if it is due to adjuvant therapy.
The late reversal and adjuvant therapy may both have an impact on the poor outcome as you
have mentioned in the paper yourself and should be taken to consideration.
I am emphasizing that the term Major LARS (Score #30) should be used and not severe LARS.
Is it right to say that there is no differences between male and female regarding major-LARS at
all in your study? If not how is that in content to previous puplications?
Gender – male; n (%) 37 (67%) 17 (68%) NS
Discussion
The reason for late stoma reversal should be mentioned and discussed as a possible explanation
for poor AF outcome. If the late reversal is due to low priority or if it is due to adjuvant therapy.
The late reversal and adjuvant therapy may both have an impact on the poor outcome as you
have mentioned in the paper yourself and should be taken to consideration
In summery I recommend this paper to be published with this minor considerations
Title: Long term persistence and risk factors for anorectal symptoms following low anterior
resection for rectal cancer
Version: 2 Date: 01 Oct 2023
Reviewer's report:
Well written paper evaluating anorectal function (AF) in patients undergoing Low Anterior
Resection (LAR) with defunctioning stoma (DS) for cancer.
An important subject that help understanding the impact of rectal resection and constructing an
anastomosis of anal canal with the sigmoid colon at the level of pelvic floor.  It is a well-known
phenomenon and generally called Low Anterior Resection Syndrome (LARS).
I comment each part separately to give as distinct feedback as possible.
Title
I suggest that the title indicate somehow that the paper even evaluates the impact of DS on AF.
Abstract
I suggest the use of LAR instead of sphincter preserving surgery due to the last mentioned term
dos not strictly indicate, total mesorectal excision (TME) while LAR does, an important detail
that partially explains the poor AF outcomes after surgery.
The term severe LARS is unnecessary because the LARS Score already has categorized LARS
to 3 categories no-LARS, minor-LARS and major-LARS. Terms that should be used throughout
the paper instead of severe or mild LARS.
Introduction
Some spelling correction The R is missing in Rectal second line.
Some repetitive segments in first paragraph “decrease of the need for abdominoperineal
resection with colostomy”
Suggest additional references when indicated LARS and quality of life, second paragraph.
It should be risk for recurrence and not chance of recurrence when mentioning the role of
adjuvant chemotherapy and risk for major-LARS.
Design
The paper is a population based prospective design in my opinion due to the intervention in this
study is done prospectively (the questionnaires) even if it has a retrospective part.
Method
It should stay if the LARS score is validated to Hebrew language in Israel with references.
Results
The reason for late stoma reversal should be mentioned and discussed as a possible explanation
for poor AF outcome. If the late reversal is due to low priority or if it is due to adjuvant therapy.
The late reversal and adjuvant therapy may both have an impact on the poor outcome as you
have mentioned in the paper yourself and should be taken to consideration.
I am emphasizing that the term Major LARS (Score #30) should be used and not severe LARS.
Is it right to say that there is no differences between male and female regarding major-LARS at
all in your study? If not how is that in content to previous puplications?
Gender – male; n (%) 37 (67%) 17 (68%) NS
Discussion
The reason for late stoma reversal should be mentioned and discussed as a possible explanation
for poor AF outcome. If the late reversal is due to low priority or if it is due to adjuvant therapy.
The late reversal and adjuvant therapy may both have an impact on the poor outcome as you
have mentioned in the paper yourself and should be taken to consideration
In summery I recommend this paper to be published with this minor considerations
Please review this paper.
user
Title: Long term persistence and risk factors for anorectal symptoms following low anterior
resection for rectal cancer
Version: 2 Date: 01 Oct 2023
Reviewer's report:
Well written paper evaluating anorectal function (AF) in patients undergoing Low Anterior
Resection (LAR) with defunctioning stoma (DS) for cancer.
An important subject that help understanding the impact of rectal resection and constructing an
anastomosis of anal canal with the sigmoid colon at the level of pelvic floor.  It is a well-known
phenomenon and generally called Low Anterior Resection Syndrome (LARS).
I comment each part separately to give as distinct feedback as possible.
Title
I suggest that the title indicate somehow that the paper even evaluates the impact of DS on AF.
Abstract
I suggest the use of LAR instead of sphincter preserving surgery due to the last mentioned term
dos not strictly indicate, total mesorectal excision (TME) while LAR does, an important detail
that partially explains the poor AF outcomes after surgery.
The term severe LARS is unnecessary because the LARS Score already has categorized LARS
to 3 categories no-LARS, minor-LARS and major-LARS. Terms that should be used throughout
the paper instead of severe or mild LARS.
Introduction
Some spelling correction The R is missing in Rectal second line.
Some repetitive segments in first paragraph “decrease of the need for abdominoperineal
resection with colostomy”
Suggest additional references when indicated LARS and quality of life, second paragraph.
It should be risk for recurrence and not chance of recurrence when mentioning the role of
adjuvant chemotherapy and risk for major-LARS.
Design
The paper is a population based prospective design in my opinion due to the intervention in this
study is done prospectively (the questionnaires) even if it has a retrospective part.
Method
It should stay if the LARS score is validated to Hebrew language in Israel with references.
Results
The reason for late stoma reversal should be mentioned and discussed as a possible explanation
for poor AF outcome. If the late reversal is due to low priority or if it is due to adjuvant therapy.
The late reversal and adjuvant therapy may both have an impact on the poor outcome as you
have mentioned in the paper yourself and should be taken to consideration.
I am emphasizing that the term Major LARS (Score #30) should be used and not severe LARS.
Is it right to say that there is no differences between male and female regarding major-LARS at
all in your study? If not how is that in content to previous puplications?
Gender – male; n (%) 37 (67%) 17 (68%) NS
Discussion
The reason for late stoma reversal should be mentioned and discussed as a possible explanation
for poor AF outcome. If the late reversal is due to low priority or if it is due to adjuvant therapy.
The late reversal and adjuvant therapy may both have an impact on the poor outcome as you
have mentioned in the paper yourself and should be taken to consideration
In summery I recommend this paper to be published with this minor considerations
assistant