Title: Prognostic Impact of a 3-week Multimodal Prehabilitation Program on Frail Elderly
Patients Undergoing Elective Gastric Cancer Surgery:  A Randomized Trial
Version: 2 Date: 14 Aug 2024
Reviewer's report:
I was asked to review a manuscript entitled: "Prognostic Impact of a 3-week Multimodal
Prehabilitation Program on Frail Elderly Patients Undergoing Elective Gastric Cancer Surgery:
A Randomized Trial". In this trial the authors assess the impact of a 3 week prehabilitation
intervention on postoperative complications, 6mwt and other secondary outcomes. The results of
the study go in line with different prehabilitation studies published where we see a trend towards
decreased overall complications, with a major significant decrease in medical complications
(especially cardio-respiratory complications). The authors also conclude that prehab patients
return to baseline functional capacity faster than the control group, a finding also in line
with other prehabilitation publications. The authors should be congratulated on the initiative,
especially  considering the lack of funding for the study.  Here are a few points that, in my
opinion, should be addressed.
- Introduction, Page 5, the sentence !Nonetheless, definitive evidence on multimodal
rehabilitation specifically tailored to this vulnerable population is lacking." I believe the sentence
should read prehabiliation and not rehabilitation.
- Methodology section: the intervention needs to be more detailed. Please specify if it was home-
based program or if it was performed in a community based facility or in the hospital. Also
specify if patients were supervised during their exercises and what kind of supervision they were
subjected to (sports medicine, kinesiology, physiotherapy, ...?).
- On the same page, the sentence. "A designated physical therapist supervises the resistance
exercises and offers corrective guidance" should be written in past tense, like the rest of the
paragraph.
- What do authors refer to when they say "Respiratory training"? Is it inspiratory muscle training
or is it an incentive inspirometry? Please detail this intervention.
- Nutrition: was any screening or assessment tool for malnutrition used?
- Adherence or fidelity to the intervention is not specified anywhere in the manuscript, but in the
discussion the authors explain that the non-compliant patients were excluded. Could you clarify
this? if data for adherence or fidelity to each component is available, it would be interesting to
show it, since most prehabilitation interventions in the eldery systematically have difficulties
due to compliance to HIIT.
- Linked to the previous comment: was the analysis performed as an intention to treat or as a
per protocol analysis? Please specify.
Title: Prognostic Impact of a 3-week Multimodal Prehabilitation Program on Frail Elderly
Patients Undergoing Elective Gastric Cancer Surgery:  A Randomized Trial
Version: 2 Date: 14 Aug 2024
Reviewer's report:
I was asked to review a manuscript entitled: "Prognostic Impact of a 3-week Multimodal
Prehabilitation Program on Frail Elderly Patients Undergoing Elective Gastric Cancer Surgery:
A Randomized Trial". In this trial the authors assess the impact of a 3 week prehabilitation
intervention on postoperative complications, 6mwt and other secondary outcomes. The results of
the study go in line with different prehabilitation studies published where we see a trend towards
decreased overall complications, with a major significant decrease in medical complications
(especially cardio-respiratory complications). The authors also conclude that prehab patients
return to baseline functional capacity faster than the control group, a finding also in line
with other prehabilitation publications. The authors should be congratulated on the initiative,
especially  considering the lack of funding for the study.  Here are a few points that, in my
opinion, should be addressed.
- Introduction, Page 5, the sentence !Nonetheless, definitive evidence on multimodal
rehabilitation specifically tailored to this vulnerable population is lacking." I believe the sentence
should read prehabiliation and not rehabilitation.
- Methodology section: the intervention needs to be more detailed. Please specify if it was home-
based program or if it was performed in a community based facility or in the hospital. Also
specify if patients were supervised during their exercises and what kind of supervision they were
subjected to (sports medicine, kinesiology, physiotherapy, ...?).
- On the same page, the sentence. "A designated physical therapist supervises the resistance
exercises and offers corrective guidance" should be written in past tense, like the rest of the
paragraph.
- What do authors refer to when they say "Respiratory training"? Is it inspiratory muscle training
or is it an incentive inspirometry? Please detail this intervention.
- Nutrition: was any screening or assessment tool for malnutrition used?
- Adherence or fidelity to the intervention is not specified anywhere in the manuscript, but in the
discussion the authors explain that the non-compliant patients were excluded. Could you clarify
this? if data for adherence or fidelity to each component is available, it would be interesting to
show it, since most prehabilitation interventions in the eldery systematically have difficulties
due to compliance to HIIT.
- Linked to the previous comment: was the analysis performed as an intention to treat or as a
per protocol analysis? Please specify.
Please review this paper.
user
Title: Prognostic Impact of a 3-week Multimodal Prehabilitation Program on Frail Elderly
Patients Undergoing Elective Gastric Cancer Surgery:  A Randomized Trial
Version: 2 Date: 14 Aug 2024
Reviewer's report:
I was asked to review a manuscript entitled: "Prognostic Impact of a 3-week Multimodal
Prehabilitation Program on Frail Elderly Patients Undergoing Elective Gastric Cancer Surgery:
A Randomized Trial". In this trial the authors assess the impact of a 3 week prehabilitation
intervention on postoperative complications, 6mwt and other secondary outcomes. The results of
the study go in line with different prehabilitation studies published where we see a trend towards
decreased overall complications, with a major significant decrease in medical complications
(especially cardio-respiratory complications). The authors also conclude that prehab patients
return to baseline functional capacity faster than the control group, a finding also in line
with other prehabilitation publications. The authors should be congratulated on the initiative,
especially  considering the lack of funding for the study.  Here are a few points that, in my
opinion, should be addressed.
- Introduction, Page 5, the sentence !Nonetheless, definitive evidence on multimodal
rehabilitation specifically tailored to this vulnerable population is lacking." I believe the sentence
should read prehabiliation and not rehabilitation.
- Methodology section: the intervention needs to be more detailed. Please specify if it was home-
based program or if it was performed in a community based facility or in the hospital. Also
specify if patients were supervised during their exercises and what kind of supervision they were
subjected to (sports medicine, kinesiology, physiotherapy, ...?).
- On the same page, the sentence. "A designated physical therapist supervises the resistance
exercises and offers corrective guidance" should be written in past tense, like the rest of the
paragraph.
- What do authors refer to when they say "Respiratory training"? Is it inspiratory muscle training
or is it an incentive inspirometry? Please detail this intervention.
- Nutrition: was any screening or assessment tool for malnutrition used?
- Adherence or fidelity to the intervention is not specified anywhere in the manuscript, but in the
discussion the authors explain that the non-compliant patients were excluded. Could you clarify
this? if data for adherence or fidelity to each component is available, it would be interesting to
show it, since most prehabilitation interventions in the eldery systematically have difficulties
due to compliance to HIIT.
- Linked to the previous comment: was the analysis performed as an intention to treat or as a
per protocol analysis? Please specify.
assistant