Title: Postoperative inpatient exercise facilitates recovery after laparoscopic surgery in
colorectal cancer patients: a randomized controlled trial
Version: 2 Date: 22 Jan 2023
Reviewer:  James A Chiarotto
Reviewer's report:
The authors have asked a clinically relevant question about  shortening length of stay for patients
undergoing curative-intent surgery for early stage colon cancer.A valid secondary endpoint was
to better prepare the patients for discharge and life at home.  The manuscript was well written
and easy to understand for its intended audience.
The major observations will be listed first. The goal of the work was to meaningfully reduce
the length of stay (LOS) for these surgical patients. The manuscript states that a clinically
meaningful reduction according to "medical staff" would be at least 0.8 days. I would like to
know who exactly was involved in this decision and what factors were taken into account to
arrive at this figure.  Additionally, the manuscript documented a median reduction in LOS of
0.5 days, which is less than the considered goal of 0.8 days. While 0.5 days is statistically
significant, it would not be clinically significant by the manuscript's definition. Please explain
this discrepancy.
A reduction in LOS is a welcomed result as long as it does not result in an increased rate of
readmission. The manuscript mentions this concept, but does not show data to support the the
experimental group not requiring more admissions. I assume this was measured. Please include
this metric in the manuscript or state why it would not be needed.
It is likely that the patients recruited for this study were all patients receiving the appropriate
surgery at the participating centre. Please state in the methods whether all such patients were
approached for inclusion, i.e. sequentially asked to participate.
Minor observations would include stating who it was that did the morphometric measurements
and whether the same person did them for the same patient.  Was the exercise specialist a physical
therapist, kinesiologist, or is an "exercise specialist" a defined healthcare worker in your practice
setting? In the abstract, describing the surgery as "curative-intent" rather that "curative" would
be more accurate. Please state that the tool (pt-RHDS) that was used is validated and reliable
in your patient population. Were any injuries reported in the exercise group? I think the reader
would appreciate more detail for how the  muscle mass measurement is determined.
With the above issues addressed, the recommendation is for acceptance for publication.
Title: Postoperative inpatient exercise facilitates recovery after laparoscopic surgery in
colorectal cancer patients: a randomized controlled trial
Version: 2 Date: 22 Jan 2023
Reviewer:  James A Chiarotto
Reviewer's report:
The authors have asked a clinically relevant question about  shortening length of stay for patients
undergoing curative-intent surgery for early stage colon cancer.A valid secondary endpoint was
to better prepare the patients for discharge and life at home.  The manuscript was well written
and easy to understand for its intended audience.
The major observations will be listed first. The goal of the work was to meaningfully reduce
the length of stay (LOS) for these surgical patients. The manuscript states that a clinically
meaningful reduction according to "medical staff" would be at least 0.8 days. I would like to
know who exactly was involved in this decision and what factors were taken into account to
arrive at this figure.  Additionally, the manuscript documented a median reduction in LOS of
0.5 days, which is less than the considered goal of 0.8 days. While 0.5 days is statistically
significant, it would not be clinically significant by the manuscript's definition. Please explain
this discrepancy.
A reduction in LOS is a welcomed result as long as it does not result in an increased rate of
readmission. The manuscript mentions this concept, but does not show data to support the the
experimental group not requiring more admissions. I assume this was measured. Please include
this metric in the manuscript or state why it would not be needed.
It is likely that the patients recruited for this study were all patients receiving the appropriate
surgery at the participating centre. Please state in the methods whether all such patients were
approached for inclusion, i.e. sequentially asked to participate.
Minor observations would include stating who it was that did the morphometric measurements
and whether the same person did them for the same patient.  Was the exercise specialist a physical
therapist, kinesiologist, or is an "exercise specialist" a defined healthcare worker in your practice
setting? In the abstract, describing the surgery as "curative-intent" rather that "curative" would
be more accurate. Please state that the tool (pt-RHDS) that was used is validated and reliable
in your patient population. Were any injuries reported in the exercise group? I think the reader
would appreciate more detail for how the  muscle mass measurement is determined.
With the above issues addressed, the recommendation is for acceptance for publication.
Please review this paper.
user
Title: Postoperative inpatient exercise facilitates recovery after laparoscopic surgery in
colorectal cancer patients: a randomized controlled trial
Version: 2 Date: 22 Jan 2023
Reviewer:  James A Chiarotto
Reviewer's report:
The authors have asked a clinically relevant question about  shortening length of stay for patients
undergoing curative-intent surgery for early stage colon cancer.A valid secondary endpoint was
to better prepare the patients for discharge and life at home.  The manuscript was well written
and easy to understand for its intended audience.
The major observations will be listed first. The goal of the work was to meaningfully reduce
the length of stay (LOS) for these surgical patients. The manuscript states that a clinically
meaningful reduction according to "medical staff" would be at least 0.8 days. I would like to
know who exactly was involved in this decision and what factors were taken into account to
arrive at this figure.  Additionally, the manuscript documented a median reduction in LOS of
0.5 days, which is less than the considered goal of 0.8 days. While 0.5 days is statistically
significant, it would not be clinically significant by the manuscript's definition. Please explain
this discrepancy.
A reduction in LOS is a welcomed result as long as it does not result in an increased rate of
readmission. The manuscript mentions this concept, but does not show data to support the the
experimental group not requiring more admissions. I assume this was measured. Please include
this metric in the manuscript or state why it would not be needed.
It is likely that the patients recruited for this study were all patients receiving the appropriate
surgery at the participating centre. Please state in the methods whether all such patients were
approached for inclusion, i.e. sequentially asked to participate.
Minor observations would include stating who it was that did the morphometric measurements
and whether the same person did them for the same patient.  Was the exercise specialist a physical
therapist, kinesiologist, or is an "exercise specialist" a defined healthcare worker in your practice
setting? In the abstract, describing the surgery as "curative-intent" rather that "curative" would
be more accurate. Please state that the tool (pt-RHDS) that was used is validated and reliable
in your patient population. Were any injuries reported in the exercise group? I think the reader
would appreciate more detail for how the  muscle mass measurement is determined.
With the above issues addressed, the recommendation is for acceptance for publication.
assistant