Title: Long-term prognosis of curative endoscopic submucosal dissection for early colorectal
cancer according to submucosal invasion: A multicenter cohort study
Version: 1 Date: 31 Jul 2022
Reviewer:  Katsumi Yamamoto
Reviewer's report:
Dear authors,
Thank you for reviewing a manuscript titled “Long-term prognosis of curative endoscopic
submucosal dissection for early colorectal cancer according to submucosal invasion: A
multicenter cohort study”
This manuscript seems to be a very valuable multicenter cohort study regarding long-term
prognosis of curative endoscopic submucosal dissection for early colorectal cancer. This study
includes a large number of colorectal ESD cases at Korean institutions and seems to reflect
the reality. I also agree with their conclusion. On the other hand, I am very interested in
your recurrent cases in curative resection. A distant or regional LN metastasis occurred in two
intramucosal cancer cases and two SM1 cancers. Besides, those three cases except piecemeal
resection were resected in en bloc and margin negative. In general, CT test following ESD is
not performed in case of intramucosal cancer. I have two suggestions as follows.
1. Immunostaining of D2-40 and VB are often performed for detection of lymphovascular
invasion, but there is no description in this manuscript. Lymphovascular invasion is a crucial
risk of metastasis, and it occurs not only submucosal cancer but also intramucosal cancer,
rarely though. At our and other institutions, immunostaining of D2-40 and VB is performed
in all cases of submucosal cancers, and a small number of intramucosal cancer in case that
lymphovascular invasions are suspected. Authors should discuss recurrent cases in more details
and the immunostaining of D2-40 and VB.
2. Secondly, the authors should describe the depth of submucosal dissection. Some endoscopists
dissect deep submucosal layers just above the muscle layer, but others dissect shallower layer. If
shallow submucosal layer was dissected, lymphovascular invasion could be missed. Therefore,
the depth of submucosal dissection is very important for precise histopathological examination.
In a Japanese report, more than 500µm of the distance between the deepest part of cancer
invasion and vertical margin is favorable, although it is controversial. Authors should investigate
the deepest part of cancer invasion and vertical margin in recurrent cases of submucosal cancers,
and discuss the depth of submucosal dissection.
I guess the discussion about those two problems are mandatory for the best treatment of
colorectal ESD. If those suggestions are properly dealt, this manuscript will be more valuable.
Title: Long-term prognosis of curative endoscopic submucosal dissection for early colorectal
cancer according to submucosal invasion: A multicenter cohort study
Version: 1 Date: 31 Jul 2022
Reviewer:  Katsumi Yamamoto
Reviewer's report:
Dear authors,
Thank you for reviewing a manuscript titled “Long-term prognosis of curative endoscopic
submucosal dissection for early colorectal cancer according to submucosal invasion: A
multicenter cohort study”
This manuscript seems to be a very valuable multicenter cohort study regarding long-term
prognosis of curative endoscopic submucosal dissection for early colorectal cancer. This study
includes a large number of colorectal ESD cases at Korean institutions and seems to reflect
the reality. I also agree with their conclusion. On the other hand, I am very interested in
your recurrent cases in curative resection. A distant or regional LN metastasis occurred in two
intramucosal cancer cases and two SM1 cancers. Besides, those three cases except piecemeal
resection were resected in en bloc and margin negative. In general, CT test following ESD is
not performed in case of intramucosal cancer. I have two suggestions as follows.
1. Immunostaining of D2-40 and VB are often performed for detection of lymphovascular
invasion, but there is no description in this manuscript. Lymphovascular invasion is a crucial
risk of metastasis, and it occurs not only submucosal cancer but also intramucosal cancer,
rarely though. At our and other institutions, immunostaining of D2-40 and VB is performed
in all cases of submucosal cancers, and a small number of intramucosal cancer in case that
lymphovascular invasions are suspected. Authors should discuss recurrent cases in more details
and the immunostaining of D2-40 and VB.
2. Secondly, the authors should describe the depth of submucosal dissection. Some endoscopists
dissect deep submucosal layers just above the muscle layer, but others dissect shallower layer. If
shallow submucosal layer was dissected, lymphovascular invasion could be missed. Therefore,
the depth of submucosal dissection is very important for precise histopathological examination.
In a Japanese report, more than 500µm of the distance between the deepest part of cancer
invasion and vertical margin is favorable, although it is controversial. Authors should investigate
the deepest part of cancer invasion and vertical margin in recurrent cases of submucosal cancers,
and discuss the depth of submucosal dissection.
I guess the discussion about those two problems are mandatory for the best treatment of
colorectal ESD. If those suggestions are properly dealt, this manuscript will be more valuable.
Please review this paper.
user
Title: Long-term prognosis of curative endoscopic submucosal dissection for early colorectal
cancer according to submucosal invasion: A multicenter cohort study
Version: 1 Date: 31 Jul 2022
Reviewer:  Katsumi Yamamoto
Reviewer's report:
Dear authors,
Thank you for reviewing a manuscript titled “Long-term prognosis of curative endoscopic
submucosal dissection for early colorectal cancer according to submucosal invasion: A
multicenter cohort study”
This manuscript seems to be a very valuable multicenter cohort study regarding long-term
prognosis of curative endoscopic submucosal dissection for early colorectal cancer. This study
includes a large number of colorectal ESD cases at Korean institutions and seems to reflect
the reality. I also agree with their conclusion. On the other hand, I am very interested in
your recurrent cases in curative resection. A distant or regional LN metastasis occurred in two
intramucosal cancer cases and two SM1 cancers. Besides, those three cases except piecemeal
resection were resected in en bloc and margin negative. In general, CT test following ESD is
not performed in case of intramucosal cancer. I have two suggestions as follows.
1. Immunostaining of D2-40 and VB are often performed for detection of lymphovascular
invasion, but there is no description in this manuscript. Lymphovascular invasion is a crucial
risk of metastasis, and it occurs not only submucosal cancer but also intramucosal cancer,
rarely though. At our and other institutions, immunostaining of D2-40 and VB is performed
in all cases of submucosal cancers, and a small number of intramucosal cancer in case that
lymphovascular invasions are suspected. Authors should discuss recurrent cases in more details
and the immunostaining of D2-40 and VB.
2. Secondly, the authors should describe the depth of submucosal dissection. Some endoscopists
dissect deep submucosal layers just above the muscle layer, but others dissect shallower layer. If
shallow submucosal layer was dissected, lymphovascular invasion could be missed. Therefore,
the depth of submucosal dissection is very important for precise histopathological examination.
In a Japanese report, more than 500µm of the distance between the deepest part of cancer
invasion and vertical margin is favorable, although it is controversial. Authors should investigate
the deepest part of cancer invasion and vertical margin in recurrent cases of submucosal cancers,
and discuss the depth of submucosal dissection.
I guess the discussion about those two problems are mandatory for the best treatment of
colorectal ESD. If those suggestions are properly dealt, this manuscript will be more valuable.
assistant