Reviewer’s report
Title: 
Preoptimisation in patients with acute obstructive colon cancer
(PREOCC) – a prospective registration study protocol.
Version: 
0 
Date: 
21 Nov 2022
Reviewer's report:
This study proposes to analyze whether the implementation of a pre-optimization
process for patients with obstruction due to colon cancer can improve the time
free from major and minor complications, and mortality, up to 90 days. For this,
they have written this protocol that sets a fairly clear goal in this regard.
From my own area of knowledge and experience, the protocol, despite showing
the knowledge of the surgical aspects of the research team, would require greater
detail in many of the methodological sections. Here are some of the most
important aspects that, from my point of view, would require attention.
1. The order of the sections of the methodology should be improved.
2. The authors do not specify the type of study design, or whether it is a single-
center or multicenter study. Also, it would be necessary to specify the criterion
of high suspicion of OCC, give some reference on the SNAQ questionnaire, or
how the analysis will consider patients who finally need to intervene without
waiting for the end of the intervention.
3. It is also very vague about the type of physiotherapy or exercises that will be
applied to the patients, or whether the entire intervention will be carried out on
an outpatient basis or always in-hospital. In addition, it should be clear how
(scheduled face-to-face visit, e-consultation, or others) and who will determine
the patient's condition and possible complications after 90 days.
4. It should be detailed which variables are descriptive (comorbidities?age?,
tumour characteristics?...), or of the process (surgical procedures? or nutrition?
exercices?.....), and which others are going to be considered endpoints properly
(complications free survival?...). And if these endpoints are going to be evaluated
only after 90 days or also throughout the follow-up period and at what specific
moment.
5. I miss an analysis section, that specifies the techniques to be used and with
what intention, as well as if they are going to carry out comparisons with other
patients or periods prior to the launch of the study.
6. In the discussion, perhaps the authors focus too much on surgical aspects
(which do not seem like they are going to modify) and not so much on the
possible benefits or limitations of carrying out a preoptimization
In conclusion, I consider that the study the authors propose requires many
improvements for publication, some of which have been noted in this review.
Publons Reviewer Recognition
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for the benefit of Publons and you as a reviewer, carefully considering the
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a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
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No
Declaration of competing interests
Please complete 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 this 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 applying 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 yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Preoptimisation in patients with acute obstructive colon cancer
(PREOCC) – a prospective registration study protocol.
Version: 
0 
Date: 
21 Nov 2022
Reviewer's report:
This study proposes to analyze whether the implementation of a pre-optimization
process for patients with obstruction due to colon cancer can improve the time
free from major and minor complications, and mortality, up to 90 days. For this,
they have written this protocol that sets a fairly clear goal in this regard.
From my own area of knowledge and experience, the protocol, despite showing
the knowledge of the surgical aspects of the research team, would require greater
detail in many of the methodological sections. Here are some of the most
important aspects that, from my point of view, would require attention.
1. The order of the sections of the methodology should be improved.
2. The authors do not specify the type of study design, or whether it is a single-
center or multicenter study. Also, it would be necessary to specify the criterion
of high suspicion of OCC, give some reference on the SNAQ questionnaire, or
how the analysis will consider patients who finally need to intervene without
waiting for the end of the intervention.
3. It is also very vague about the type of physiotherapy or exercises that will be
applied to the patients, or whether the entire intervention will be carried out on
an outpatient basis or always in-hospital. In addition, it should be clear how
(scheduled face-to-face visit, e-consultation, or others) and who will determine
the patient's condition and possible complications after 90 days.
4. It should be detailed which variables are descriptive (comorbidities?age?,
tumour characteristics?...), or of the process (surgical procedures? or nutrition?
exercices?.....), and which others are going to be considered endpoints properly
(complications free survival?...). And if these endpoints are going to be evaluated
only after 90 days or also throughout the follow-up period and at what specific
moment.
5. I miss an analysis section, that specifies the techniques to be used and with
what intention, as well as if they are going to carry out comparisons with other
patients or periods prior to the launch of the study.
6. In the discussion, perhaps the authors focus too much on surgical aspects
(which do not seem like they are going to modify) and not so much on the
possible benefits or limitations of carrying out a preoptimization
In conclusion, I consider that the study the authors propose requires many
improvements for publication, some of which have been noted in this review.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
Declaration of competing interests
Please complete 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 this 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 applying 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 yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Preoptimisation in patients with acute obstructive colon cancer
(PREOCC) – a prospective registration study protocol.
Version: 
0 
Date: 
21 Nov 2022
Reviewer's report:
This study proposes to analyze whether the implementation of a pre-optimization
process for patients with obstruction due to colon cancer can improve the time
free from major and minor complications, and mortality, up to 90 days. For this,
they have written this protocol that sets a fairly clear goal in this regard.
From my own area of knowledge and experience, the protocol, despite showing
the knowledge of the surgical aspects of the research team, would require greater
detail in many of the methodological sections. Here are some of the most
important aspects that, from my point of view, would require attention.
1. The order of the sections of the methodology should be improved.
2. The authors do not specify the type of study design, or whether it is a single-
center or multicenter study. Also, it would be necessary to specify the criterion
of high suspicion of OCC, give some reference on the SNAQ questionnaire, or
how the analysis will consider patients who finally need to intervene without
waiting for the end of the intervention.
3. It is also very vague about the type of physiotherapy or exercises that will be
applied to the patients, or whether the entire intervention will be carried out on
an outpatient basis or always in-hospital. In addition, it should be clear how
(scheduled face-to-face visit, e-consultation, or others) and who will determine
the patient's condition and possible complications after 90 days.
4. It should be detailed which variables are descriptive (comorbidities?age?,
tumour characteristics?...), or of the process (surgical procedures? or nutrition?
exercices?.....), and which others are going to be considered endpoints properly
(complications free survival?...). And if these endpoints are going to be evaluated
only after 90 days or also throughout the follow-up period and at what specific
moment.
5. I miss an analysis section, that specifies the techniques to be used and with
what intention, as well as if they are going to carry out comparisons with other
patients or periods prior to the launch of the study.
6. In the discussion, perhaps the authors focus too much on surgical aspects
(which do not seem like they are going to modify) and not so much on the
possible benefits or limitations of carrying out a preoptimization
In conclusion, I consider that the study the authors propose requires many
improvements for publication, some of which have been noted in this review.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
Declaration of competing interests
Please complete 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 this 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 applying 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 yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant