Title: Prognosis of Incompletely Resected Small Rectal Neuroendocrine Tumor using
Endoscope without Additional Treatment
Version: 2 Date: 16 Apr 2022
Reviewer's report:
This is an interesting article on an important topic where there is very limited literature. The
paper is well written and provides some reassurance about the incomplete resection of small
rectal NENs. I have some minor comments:
1. line 81: The staging before resection included only CT imaging. Similarly (line 117) follow-
up imaging included only CT. More sensitive imaging techniques, such as MRI rectum and
Gallium-68 PET/CT were not used. Such techniques would be more sensitive to detect small
recurrences or small volume metastatic disease. The authors need to comment on this in their
discussion and mention this as a limitation.
2. lines 131-132: ESMR-L appeared to be much more effective than ESD in achieving complete
resections. While I agree with the authors that this should be the procedure of choice for small
(<10mm) rectal NETs, and this is also the consensus in the literature, (given safety, procedural
time and clinical effectiveness), I would like them to discuss a bit more if possible how they
explain this big difference in incomplete resection rates (4.4% incomplete resection in ESMR-
L vs 52.4% in ESD). In particular, the ESD incomplete resection rate seems very high. Can the
authors include in their discussion what the incomplete resection rates of small rectal NETs  by
ESD are in other studies (for comparison) ?
3. Table 2: Authors need to mention that CT was used as the method for detection of recurrence/
metastatic disease.
4. The issue of incomplete resection of small rectal NETs is a common problem in clinical
practice. In their discussion, could the authors suggest what should be done in these cases based
on their experience and the published literature. This would be helpful to the readers. What is
their strategy when they receive a patient with incompletely resected small rectal NET, how do
they assess it, what imaging do they arrange, do they resect the scar or simply assess or biopsy
the scar etc. A step-by-step approach of what should be done would be useful.
Title: Prognosis of Incompletely Resected Small Rectal Neuroendocrine Tumor using
Endoscope without Additional Treatment
Version: 2 Date: 16 Apr 2022
Reviewer's report:
This is an interesting article on an important topic where there is very limited literature. The
paper is well written and provides some reassurance about the incomplete resection of small
rectal NENs. I have some minor comments:
1. line 81: The staging before resection included only CT imaging. Similarly (line 117) follow-
up imaging included only CT. More sensitive imaging techniques, such as MRI rectum and
Gallium-68 PET/CT were not used. Such techniques would be more sensitive to detect small
recurrences or small volume metastatic disease. The authors need to comment on this in their
discussion and mention this as a limitation.
2. lines 131-132: ESMR-L appeared to be much more effective than ESD in achieving complete
resections. While I agree with the authors that this should be the procedure of choice for small
(<10mm) rectal NETs, and this is also the consensus in the literature, (given safety, procedural
time and clinical effectiveness), I would like them to discuss a bit more if possible how they
explain this big difference in incomplete resection rates (4.4% incomplete resection in ESMR-
L vs 52.4% in ESD). In particular, the ESD incomplete resection rate seems very high. Can the
authors include in their discussion what the incomplete resection rates of small rectal NETs  by
ESD are in other studies (for comparison) ?
3. Table 2: Authors need to mention that CT was used as the method for detection of recurrence/
metastatic disease.
4. The issue of incomplete resection of small rectal NETs is a common problem in clinical
practice. In their discussion, could the authors suggest what should be done in these cases based
on their experience and the published literature. This would be helpful to the readers. What is
their strategy when they receive a patient with incompletely resected small rectal NET, how do
they assess it, what imaging do they arrange, do they resect the scar or simply assess or biopsy
the scar etc. A step-by-step approach of what should be done would be useful.
Please review this paper.
user
Title: Prognosis of Incompletely Resected Small Rectal Neuroendocrine Tumor using
Endoscope without Additional Treatment
Version: 2 Date: 16 Apr 2022
Reviewer's report:
This is an interesting article on an important topic where there is very limited literature. The
paper is well written and provides some reassurance about the incomplete resection of small
rectal NENs. I have some minor comments:
1. line 81: The staging before resection included only CT imaging. Similarly (line 117) follow-
up imaging included only CT. More sensitive imaging techniques, such as MRI rectum and
Gallium-68 PET/CT were not used. Such techniques would be more sensitive to detect small
recurrences or small volume metastatic disease. The authors need to comment on this in their
discussion and mention this as a limitation.
2. lines 131-132: ESMR-L appeared to be much more effective than ESD in achieving complete
resections. While I agree with the authors that this should be the procedure of choice for small
(<10mm) rectal NETs, and this is also the consensus in the literature, (given safety, procedural
time and clinical effectiveness), I would like them to discuss a bit more if possible how they
explain this big difference in incomplete resection rates (4.4% incomplete resection in ESMR-
L vs 52.4% in ESD). In particular, the ESD incomplete resection rate seems very high. Can the
authors include in their discussion what the incomplete resection rates of small rectal NETs  by
ESD are in other studies (for comparison) ?
3. Table 2: Authors need to mention that CT was used as the method for detection of recurrence/
metastatic disease.
4. The issue of incomplete resection of small rectal NETs is a common problem in clinical
practice. In their discussion, could the authors suggest what should be done in these cases based
on their experience and the published literature. This would be helpful to the readers. What is
their strategy when they receive a patient with incompletely resected small rectal NET, how do
they assess it, what imaging do they arrange, do they resect the scar or simply assess or biopsy
the scar etc. A step-by-step approach of what should be done would be useful.
assistant