Title: Low Hartmann’s procedure versus abdominoperineal resection for rectal cancer, a
propensity score matching cohort study
Version: 1 Date: 28 Jan 2024
Reviewer's report:
The authors reported "Low Hartmann’s procedure versus abdominoperineal resection for rectal
cancer, a propensity score matching cohort study". I have some comments.
1. The authors state  that "LHP was still a reliable alternative in selected RC patients when
primary anastomosis was not recommended" in conclusion. However, the authors compared
LHP and APR. In order to clarify the authors' clinical question, I believe that LHP and primary
anastomosis should be compared in cases where the distance of the tumor from the anal verge
is similar. I think there is a problem with the study design.
2. The primary outcome was the incidence of major complications in this study. Propensity
score matching was performed with a 1:2 ratio, based on gender, age, tumor stage, ASA score,
BMI, PAS, and surgical procedure. For example, preoperative treatment may be a risk factor
for postoperative complications. Please provide the rationale for choosing "gender, age, tumor
stage, ASA score, BMI, PAS, and surgical procedure" as the matching covariates.
3. I thought it would be better to evaluate whether the matching was successful or not.
For example, standardized differences can be calculated to examine imbalances in patient
characteristics before and after matching.
4. The authors state  that  "the occurrence rate of minor complications was significantly higher
in the LHP group (52% vs 21.4%, P<0.001), and the difference mainly lay in abdominal wound
infection (10% vs 0%, P=0.006) and bowel obstruction (16% vs 4.8%, P=0.028)".  LHP with
fewer pelvic defects may have a lower risk of complications compared to APR. Please explain
why LHP had more complications. I also could not understand why ileus  was more common
in LHP.
5.The authors state  that  "a higher incidence of parastomal hernia was observed in APR group
(8.3%) during the long-term follow-up".  I could not understand why parastomal hernia was
more common in LHP.
Title: Low Hartmann’s procedure versus abdominoperineal resection for rectal cancer, a
propensity score matching cohort study
Version: 1 Date: 28 Jan 2024
Reviewer's report:
The authors reported "Low Hartmann’s procedure versus abdominoperineal resection for rectal
cancer, a propensity score matching cohort study". I have some comments.
1. The authors state  that "LHP was still a reliable alternative in selected RC patients when
primary anastomosis was not recommended" in conclusion. However, the authors compared
LHP and APR. In order to clarify the authors' clinical question, I believe that LHP and primary
anastomosis should be compared in cases where the distance of the tumor from the anal verge
is similar. I think there is a problem with the study design.
2. The primary outcome was the incidence of major complications in this study. Propensity
score matching was performed with a 1:2 ratio, based on gender, age, tumor stage, ASA score,
BMI, PAS, and surgical procedure. For example, preoperative treatment may be a risk factor
for postoperative complications. Please provide the rationale for choosing "gender, age, tumor
stage, ASA score, BMI, PAS, and surgical procedure" as the matching covariates.
3. I thought it would be better to evaluate whether the matching was successful or not.
For example, standardized differences can be calculated to examine imbalances in patient
characteristics before and after matching.
4. The authors state  that  "the occurrence rate of minor complications was significantly higher
in the LHP group (52% vs 21.4%, P<0.001), and the difference mainly lay in abdominal wound
infection (10% vs 0%, P=0.006) and bowel obstruction (16% vs 4.8%, P=0.028)".  LHP with
fewer pelvic defects may have a lower risk of complications compared to APR. Please explain
why LHP had more complications. I also could not understand why ileus  was more common
in LHP.
5.The authors state  that  "a higher incidence of parastomal hernia was observed in APR group
(8.3%) during the long-term follow-up".  I could not understand why parastomal hernia was
more common in LHP.
Please review this paper.
user
Title: Low Hartmann’s procedure versus abdominoperineal resection for rectal cancer, a
propensity score matching cohort study
Version: 1 Date: 28 Jan 2024
Reviewer's report:
The authors reported "Low Hartmann’s procedure versus abdominoperineal resection for rectal
cancer, a propensity score matching cohort study". I have some comments.
1. The authors state  that "LHP was still a reliable alternative in selected RC patients when
primary anastomosis was not recommended" in conclusion. However, the authors compared
LHP and APR. In order to clarify the authors' clinical question, I believe that LHP and primary
anastomosis should be compared in cases where the distance of the tumor from the anal verge
is similar. I think there is a problem with the study design.
2. The primary outcome was the incidence of major complications in this study. Propensity
score matching was performed with a 1:2 ratio, based on gender, age, tumor stage, ASA score,
BMI, PAS, and surgical procedure. For example, preoperative treatment may be a risk factor
for postoperative complications. Please provide the rationale for choosing "gender, age, tumor
stage, ASA score, BMI, PAS, and surgical procedure" as the matching covariates.
3. I thought it would be better to evaluate whether the matching was successful or not.
For example, standardized differences can be calculated to examine imbalances in patient
characteristics before and after matching.
4. The authors state  that  "the occurrence rate of minor complications was significantly higher
in the LHP group (52% vs 21.4%, P<0.001), and the difference mainly lay in abdominal wound
infection (10% vs 0%, P=0.006) and bowel obstruction (16% vs 4.8%, P=0.028)".  LHP with
fewer pelvic defects may have a lower risk of complications compared to APR. Please explain
why LHP had more complications. I also could not understand why ileus  was more common
in LHP.
5.The authors state  that  "a higher incidence of parastomal hernia was observed in APR group
(8.3%) during the long-term follow-up".  I could not understand why parastomal hernia was
more common in LHP.
assistant