Title: Long-term Outcomes of Additional Surgery Versus Surveillance-Only Clinical
Decision for Early Colorectal Cancer Patients After Non-curative Endoscopic Resection: A
Meta-analysis
Version: 4 Date: 19 Sep 2024
Reviewer's report:
Thank you for opportunity to review the paper titled “Long-term outcomes of additional surgery
versus surveillance-only clinical decision for early colorectal cancer patients after non-curative
endoscopic resection: a meta-analysis”.
The document has been carefully researched and written. However, there are a few issues that
I would like to address:
1. The definition of non-curative endoscopic resection is not clear. Since definitions may vary
across studies, it should be clarified in the Methods section.
2. In Japanese studies, patients classified as having non-curative endoscopic resection according
to the JSCCR criteria and who did not undergo additional surgery may have serious
comorbidities. There is a survival bias in the group that did not receive additional bowel
resection, which complicates direct comparisons of overall survival rates between those who had
additional surgery and those under surveillance only. How does the author think about this issue?
3. In Japanese studies, patients classified as having non-curative resections according to the
JSCCR criteria who do not undergo additional surgery may present with serious comorbidities.
This fact introduces a survival-related bias in the comparison between the two groups, raising
concerns about the validity of comparing overall survival rates. I believe the author should
address this issue in the Discussion.
4. What does “ER+” in Table 1 refer to? Does it indicate endoscopic resection?
5. Literature 15, which is cited twice in the Discussion, presents a study with a small sample
size of 180 cases, and I believe it may not be suitable for comparison with the results of this
meta-analysis.
Title: Long-term Outcomes of Additional Surgery Versus Surveillance-Only Clinical
Decision for Early Colorectal Cancer Patients After Non-curative Endoscopic Resection: A
Meta-analysis
Version: 4 Date: 19 Sep 2024
Reviewer's report:
Thank you for opportunity to review the paper titled “Long-term outcomes of additional surgery
versus surveillance-only clinical decision for early colorectal cancer patients after non-curative
endoscopic resection: a meta-analysis”.
The document has been carefully researched and written. However, there are a few issues that
I would like to address:
1. The definition of non-curative endoscopic resection is not clear. Since definitions may vary
across studies, it should be clarified in the Methods section.
2. In Japanese studies, patients classified as having non-curative endoscopic resection according
to the JSCCR criteria and who did not undergo additional surgery may have serious
comorbidities. There is a survival bias in the group that did not receive additional bowel
resection, which complicates direct comparisons of overall survival rates between those who had
additional surgery and those under surveillance only. How does the author think about this issue?
3. In Japanese studies, patients classified as having non-curative resections according to the
JSCCR criteria who do not undergo additional surgery may present with serious comorbidities.
This fact introduces a survival-related bias in the comparison between the two groups, raising
concerns about the validity of comparing overall survival rates. I believe the author should
address this issue in the Discussion.
4. What does “ER+” in Table 1 refer to? Does it indicate endoscopic resection?
5. Literature 15, which is cited twice in the Discussion, presents a study with a small sample
size of 180 cases, and I believe it may not be suitable for comparison with the results of this
meta-analysis.
Please review this paper.
user
Title: Long-term Outcomes of Additional Surgery Versus Surveillance-Only Clinical
Decision for Early Colorectal Cancer Patients After Non-curative Endoscopic Resection: A
Meta-analysis
Version: 4 Date: 19 Sep 2024
Reviewer's report:
Thank you for opportunity to review the paper titled “Long-term outcomes of additional surgery
versus surveillance-only clinical decision for early colorectal cancer patients after non-curative
endoscopic resection: a meta-analysis”.
The document has been carefully researched and written. However, there are a few issues that
I would like to address:
1. The definition of non-curative endoscopic resection is not clear. Since definitions may vary
across studies, it should be clarified in the Methods section.
2. In Japanese studies, patients classified as having non-curative endoscopic resection according
to the JSCCR criteria and who did not undergo additional surgery may have serious
comorbidities. There is a survival bias in the group that did not receive additional bowel
resection, which complicates direct comparisons of overall survival rates between those who had
additional surgery and those under surveillance only. How does the author think about this issue?
3. In Japanese studies, patients classified as having non-curative resections according to the
JSCCR criteria who do not undergo additional surgery may present with serious comorbidities.
This fact introduces a survival-related bias in the comparison between the two groups, raising
concerns about the validity of comparing overall survival rates. I believe the author should
address this issue in the Discussion.
4. What does “ER+” in Table 1 refer to? Does it indicate endoscopic resection?
5. Literature 15, which is cited twice in the Discussion, presents a study with a small sample
size of 180 cases, and I believe it may not be suitable for comparison with the results of this
meta-analysis.
assistant