Title: Comparison of Prognostic Outcomes between Endoscopic Submucosal Dissection and
Surgical Treatment for Early Gastric Cancer: A Retrospective Cohort Study
Version: 1 Date: 19 Nov 2023
Reviewer's report:
Dear Author,
This paper compares ESD and surgery as treatment modalities for early gastric cancer. Several
concerns have been raised about this article. Firstly, there is no description of the pathological
investigation methods. Specifically, the mention of vascular invasion raises questions about
whether lymphatic invasion is included and how this is determined. Additionally, the paper lists
only M and SM depths without specifying the depth level of the SM.
The survival and recurrence curves exhibit a notable decline at 3 and 5 years, which is
significantly more pronounced than in previous reports.  (Abdelfatah MM, et al. Long-term
outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer: a
systematic review and meta-analysis Eur J Gastroenterol Hepatol 2019 Apr;31(4):418-424.
Jeon HK, et al. Long-term outcome of endoscopic submucosal dissection is comparable to
that of surgery for early gastric cancer: a propensity-matched analysis Gastric Cancer 2018
21:133–143) Although the lesions in this study are expected to be part of the treated group
with radical resection and a favorable prognosis, factors contributing to this poor outcome need
clarification. It is imperative to address the cause of death and any forms of recurrence, if present.
A comprehensive discussion on these aspects is essential.
The absence of data on metachronous cancer is a notable gap. Given its potential impact on
prognosis, this data should be included. Furthermore, the follow-up observation period needs
to be explicitly stated.
Regarding the concluding statement, "In conclusion, our study provides evidence that ESD may
be a viable option for the treatment of early gastric cancer," comments suggesting that treatment
modalities not aligned with the indications for treatment are equivalent can be misleading to the
reader. Clarification on this point is necessary.
Title: Comparison of Prognostic Outcomes between Endoscopic Submucosal Dissection and
Surgical Treatment for Early Gastric Cancer: A Retrospective Cohort Study
Version: 1 Date: 19 Nov 2023
Reviewer's report:
Dear Author,
This paper compares ESD and surgery as treatment modalities for early gastric cancer. Several
concerns have been raised about this article. Firstly, there is no description of the pathological
investigation methods. Specifically, the mention of vascular invasion raises questions about
whether lymphatic invasion is included and how this is determined. Additionally, the paper lists
only M and SM depths without specifying the depth level of the SM.
The survival and recurrence curves exhibit a notable decline at 3 and 5 years, which is
significantly more pronounced than in previous reports.  (Abdelfatah MM, et al. Long-term
outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer: a
systematic review and meta-analysis Eur J Gastroenterol Hepatol 2019 Apr;31(4):418-424.
Jeon HK, et al. Long-term outcome of endoscopic submucosal dissection is comparable to
that of surgery for early gastric cancer: a propensity-matched analysis Gastric Cancer 2018
21:133–143) Although the lesions in this study are expected to be part of the treated group
with radical resection and a favorable prognosis, factors contributing to this poor outcome need
clarification. It is imperative to address the cause of death and any forms of recurrence, if present.
A comprehensive discussion on these aspects is essential.
The absence of data on metachronous cancer is a notable gap. Given its potential impact on
prognosis, this data should be included. Furthermore, the follow-up observation period needs
to be explicitly stated.
Regarding the concluding statement, "In conclusion, our study provides evidence that ESD may
be a viable option for the treatment of early gastric cancer," comments suggesting that treatment
modalities not aligned with the indications for treatment are equivalent can be misleading to the
reader. Clarification on this point is necessary.
Please review this paper.
user
Title: Comparison of Prognostic Outcomes between Endoscopic Submucosal Dissection and
Surgical Treatment for Early Gastric Cancer: A Retrospective Cohort Study
Version: 1 Date: 19 Nov 2023
Reviewer's report:
Dear Author,
This paper compares ESD and surgery as treatment modalities for early gastric cancer. Several
concerns have been raised about this article. Firstly, there is no description of the pathological
investigation methods. Specifically, the mention of vascular invasion raises questions about
whether lymphatic invasion is included and how this is determined. Additionally, the paper lists
only M and SM depths without specifying the depth level of the SM.
The survival and recurrence curves exhibit a notable decline at 3 and 5 years, which is
significantly more pronounced than in previous reports.  (Abdelfatah MM, et al. Long-term
outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer: a
systematic review and meta-analysis Eur J Gastroenterol Hepatol 2019 Apr;31(4):418-424.
Jeon HK, et al. Long-term outcome of endoscopic submucosal dissection is comparable to
that of surgery for early gastric cancer: a propensity-matched analysis Gastric Cancer 2018
21:133–143) Although the lesions in this study are expected to be part of the treated group
with radical resection and a favorable prognosis, factors contributing to this poor outcome need
clarification. It is imperative to address the cause of death and any forms of recurrence, if present.
A comprehensive discussion on these aspects is essential.
The absence of data on metachronous cancer is a notable gap. Given its potential impact on
prognosis, this data should be included. Furthermore, the follow-up observation period needs
to be explicitly stated.
Regarding the concluding statement, "In conclusion, our study provides evidence that ESD may
be a viable option for the treatment of early gastric cancer," comments suggesting that treatment
modalities not aligned with the indications for treatment are equivalent can be misleading to the
reader. Clarification on this point is necessary.
assistant