Title: Building a risk prediction model for anastomotic leakage postoperative low rectal cancer
based on Lasso-Logistic regression
Version: 3 Date: 05 Jun 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
1. Retrospective, Single-Center Design
The study is retrospective and conducted at a single center, which limits the generalizability and
external validity of the model.
2. Limited External Validation
Although an external validation cohort is included, it is small (n = 127) and drawn from the same
institution, raising concerns about true external validation.
3. Missing Key Predictors
Some known risk factors for AL are not included or analyzed, such as:
Use of intraoperative fluorescence imaging
Level of anastomosis (stapled vs. hand-sewn)
Use of transanal TME (taTME) techniques
Surgeon experience or volume
Justify their exclusion or acknowledge in the limitations that not all relevant factors could be
assessed.
4. Protective Stoma as a Predictor
The protective stoma is both a predictor and a potential response
Title: Building a risk prediction model for anastomotic leakage postoperative low rectal cancer
based on Lasso-Logistic regression
Version: 3 Date: 05 Jun 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
1. Retrospective, Single-Center Design
The study is retrospective and conducted at a single center, which limits the generalizability and
external validity of the model.
2. Limited External Validation
Although an external validation cohort is included, it is small (n = 127) and drawn from the same
institution, raising concerns about true external validation.
3. Missing Key Predictors
Some known risk factors for AL are not included or analyzed, such as:
Use of intraoperative fluorescence imaging
Level of anastomosis (stapled vs. hand-sewn)
Use of transanal TME (taTME) techniques
Surgeon experience or volume
Justify their exclusion or acknowledge in the limitations that not all relevant factors could be
assessed.
4. Protective Stoma as a Predictor
The protective stoma is both a predictor and a potential response
Please review this paper.
user
Title: Building a risk prediction model for anastomotic leakage postoperative low rectal cancer
based on Lasso-Logistic regression
Version: 3 Date: 05 Jun 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
1. Retrospective, Single-Center Design
The study is retrospective and conducted at a single center, which limits the generalizability and
external validity of the model.
2. Limited External Validation
Although an external validation cohort is included, it is small (n = 127) and drawn from the same
institution, raising concerns about true external validation.
3. Missing Key Predictors
Some known risk factors for AL are not included or analyzed, such as:
Use of intraoperative fluorescence imaging
Level of anastomosis (stapled vs. hand-sewn)
Use of transanal TME (taTME) techniques
Surgeon experience or volume
Justify their exclusion or acknowledge in the limitations that not all relevant factors could be
assessed.
4. Protective Stoma as a Predictor
The protective stoma is both a predictor and a potential response
assistant