Reviewer ’s report  
 
Title: Clinical Outcomes of Endoscopic Mucosal Resection for Rectal Neuroendocrine Tumor  
 
Version: 0 Date: 18 Nov 2017  
 
Reviewer: Satoshi Nagayama  
 
Reviewer's report:  
 
The authors have conducted a retrospective analysis of the patien ts with rectal NETs who 
underwent endoscopic mucosal resection. Although this report would be acceptable for 
publication, I encourage the authors to make the following changes to enhance understanding:  
1. The authors should evaluate the degree of lymphov ascular invasion (LVI) more precisely by 
specific staining (such as VB -HE) and immunohistochemical staining (D2 -40) in all cases. 
Especially in 4 cases where tumor recurred after endoscopic complete resection (Table 5), 
this factor is the most important de terminant to be clarified.  
 
2. It seems desirable to propose a surgical resection for rectal NETs more than 10mm in size, 
since the risk of metastasis to regional lymph nodes is significantly high (J Gastroenterol 
Hepatol 27, 1801 -1807, 2012). Nevertheless,  the author performed EMR in patients with 
rectal NETs more than 10mm in size. They should discuss the reason why they chose to 
perform EMR rather than surgical radical resection.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please comp lete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of t his 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently apply ing for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is y es to any, please give details below.  
 
None  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attac hments I upload will be posted on the website along with the authors'  
responses.  I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do  not wish to be included in my named report can be included as confidential comments 
to the  editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Clinical Outcomes of Endoscopic Mucosal Resection for Rectal Neuroendocrine Tumor  
 
Version: 0 Date: 18 Nov 2017  
 
Reviewer: Satoshi Nagayama  
 
Reviewer's report:  
 
The authors have conducted a retrospective analysis of the patien ts with rectal NETs who 
underwent endoscopic mucosal resection. Although this report would be acceptable for 
publication, I encourage the authors to make the following changes to enhance understanding:  
1. The authors should evaluate the degree of lymphov ascular invasion (LVI) more precisely by 
specific staining (such as VB -HE) and immunohistochemical staining (D2 -40) in all cases. 
Especially in 4 cases where tumor recurred after endoscopic complete resection (Table 5), 
this factor is the most important de terminant to be clarified.  
 
2. It seems desirable to propose a surgical resection for rectal NETs more than 10mm in size, 
since the risk of metastasis to regional lymph nodes is significantly high (J Gastroenterol 
Hepatol 27, 1801 -1807, 2012). Nevertheless,  the author performed EMR in patients with 
rectal NETs more than 10mm in size. They should discuss the reason why they chose to 
perform EMR rather than surgical radical resection.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please comp lete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of t his 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently apply ing for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is y es to any, please give details below.  
 
None  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attac hments I upload will be posted on the website along with the authors'  
responses.  I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do  not wish to be included in my named report can be included as confidential comments 
to the  editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Clinical Outcomes of Endoscopic Mucosal Resection for Rectal Neuroendocrine Tumor  
 
Version: 0 Date: 18 Nov 2017  
 
Reviewer: Satoshi Nagayama  
 
Reviewer's report:  
 
The authors have conducted a retrospective analysis of the patien ts with rectal NETs who 
underwent endoscopic mucosal resection. Although this report would be acceptable for 
publication, I encourage the authors to make the following changes to enhance understanding:  
1. The authors should evaluate the degree of lymphov ascular invasion (LVI) more precisely by 
specific staining (such as VB -HE) and immunohistochemical staining (D2 -40) in all cases. 
Especially in 4 cases where tumor recurred after endoscopic complete resection (Table 5), 
this factor is the most important de terminant to be clarified.  
 
2. It seems desirable to propose a surgical resection for rectal NETs more than 10mm in size, 
since the risk of metastasis to regional lymph nodes is significantly high (J Gastroenterol 
Hepatol 27, 1801 -1807, 2012). Nevertheless,  the author performed EMR in patients with 
rectal NETs more than 10mm in size. They should discuss the reason why they chose to 
perform EMR rather than surgical radical resection.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please comp lete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of t his 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently apply ing for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is y es to any, please give details below.  
 
None  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attac hments I upload will be posted on the website along with the authors'  
responses.  I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do  not wish to be included in my named report can be included as confidential comments 
to the  editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant