Title: High output stoma after surgery for rectal cancer - A risk factor for Low Anterior
Resection Syndrome?
Version: 1 Date: 02 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors , please address the following points below
-The study establishes a significant association between high-output stomas (HOS) and low
anterior resection syndrome (LARS); however, it fails to examine the underlying mechanisms
that contribute to this relationship. For example, inquiries regarding how the altered physiology
associated with a high-output stoma—such as fluid and electrolyte imbalance and modified
motility—causes or exacerbates LARS would enhance the discussion significantly.
-A more thorough investigation into the mechanisms linking HOS to LARS is warranted. Future
research could focus on identifying biomarkers indicative of autonomic dysfunction, intestinal
inflammation, and electrolyte imbalances to support the proposed mechanisms.
-Furthermore, the authors ought to present concrete recommendations for the management of
patients with HOS. This should specifically address the timing of stoma closure and strategies
for electrolyte management, which may assist in reducing the risk of LARS.
-In conclusion, the manuscript offers important insights into the relationship between HOS and
LARS in patients with rectal cancer, highlighting a considerable risk factor for the development
of significant LARS. Nonetheless, limitations such as the retrospective design, small sample
size of HOS patients, and potential confounding variables restrict the generalizability and
conclusiveness of the findings. While the results are encouraging, there is a pressing need
for larger, multicenter, prospective studies to validate these findings and further elucidate the
underlying mechanisms.
Title: High output stoma after surgery for rectal cancer - A risk factor for Low Anterior
Resection Syndrome?
Version: 1 Date: 02 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors , please address the following points below
-The study establishes a significant association between high-output stomas (HOS) and low
anterior resection syndrome (LARS); however, it fails to examine the underlying mechanisms
that contribute to this relationship. For example, inquiries regarding how the altered physiology
associated with a high-output stoma—such as fluid and electrolyte imbalance and modified
motility—causes or exacerbates LARS would enhance the discussion significantly.
-A more thorough investigation into the mechanisms linking HOS to LARS is warranted. Future
research could focus on identifying biomarkers indicative of autonomic dysfunction, intestinal
inflammation, and electrolyte imbalances to support the proposed mechanisms.
-Furthermore, the authors ought to present concrete recommendations for the management of
patients with HOS. This should specifically address the timing of stoma closure and strategies
for electrolyte management, which may assist in reducing the risk of LARS.
-In conclusion, the manuscript offers important insights into the relationship between HOS and
LARS in patients with rectal cancer, highlighting a considerable risk factor for the development
of significant LARS. Nonetheless, limitations such as the retrospective design, small sample
size of HOS patients, and potential confounding variables restrict the generalizability and
conclusiveness of the findings. While the results are encouraging, there is a pressing need
for larger, multicenter, prospective studies to validate these findings and further elucidate the
underlying mechanisms.
Please review this paper.
user
Title: High output stoma after surgery for rectal cancer - A risk factor for Low Anterior
Resection Syndrome?
Version: 1 Date: 02 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors , please address the following points below
-The study establishes a significant association between high-output stomas (HOS) and low
anterior resection syndrome (LARS); however, it fails to examine the underlying mechanisms
that contribute to this relationship. For example, inquiries regarding how the altered physiology
associated with a high-output stoma—such as fluid and electrolyte imbalance and modified
motility—causes or exacerbates LARS would enhance the discussion significantly.
-A more thorough investigation into the mechanisms linking HOS to LARS is warranted. Future
research could focus on identifying biomarkers indicative of autonomic dysfunction, intestinal
inflammation, and electrolyte imbalances to support the proposed mechanisms.
-Furthermore, the authors ought to present concrete recommendations for the management of
patients with HOS. This should specifically address the timing of stoma closure and strategies
for electrolyte management, which may assist in reducing the risk of LARS.
-In conclusion, the manuscript offers important insights into the relationship between HOS and
LARS in patients with rectal cancer, highlighting a considerable risk factor for the development
of significant LARS. Nonetheless, limitations such as the retrospective design, small sample
size of HOS patients, and potential confounding variables restrict the generalizability and
conclusiveness of the findings. While the results are encouraging, there is a pressing need
for larger, multicenter, prospective studies to validate these findings and further elucidate the
underlying mechanisms.
assistant