Title: Deep pelvis and low visceral fat mass as risk factors for neurogenic bladder after rectal
cancer surgery
Version: 1 Date: 13 Aug 2024
Reviewer's report:
This is an interesting study and well-designed. Authors found  link between the deep pelvic
anatomy and low VFA with postoperative neurogenic bladder. Furthermore, they demonstrated
that both are significantly related with PONB. I have a minor comments:
-what kind of robotic generations are used (da Vinci Si, Xi etc). Because, there also could alter
the operation time due to single/double docking/undocking phases.
-I didn’t find information on method regarding the preop mechanical bowel cleaning or
prophilactic antibiotherapy.
- what kind of CRT (short or long-course) are used, if possible specify in details of names in
method part.
-Are you performing bladder training by  intermittent clamping prior to removal of urinary
catheters after the rectal cancer surgery? Sometimes it may be  helpfull  to prevent urinary
retantion.
-Consider to enrich the references list, as in discussion part there is no cited  some   sentences .
Following studies which directly related with them may be  useful.
“ Many studies have emphasized the importance of measuring pelvic dimensions when planning
rectal cancer surgery to assess surgical difficulty” after this sentence may use this studies, which
conducted on male (narrow pelvis)  patients with distal rectal cancer  (deep pelvis):
Gachabayov M, Felsenreich DM, Bhatti S, Bergamaschi R; RESURRECT Study Group. Does
the visceral fat area impact the histopathology specimen metrics after total mesorectal excision
for distal rectal cancer? Langenbecks Arch Surg. 2023 Jun 30;408(1):257. doi: 10.1007/
s00423-023-02981-7. PMID: 37389686.
Felsenreich DM, Gachabayov M, Bergamaschi R; RESURRECT Study Group. Does the
mesorectal fat area impact the histopathology metrics of the specimen in males undergoing
TME for distal rectal cancer? Updates Surg. 2023 Apr;75(3):581-588. doi: 10.1007/
s13304-022-01429-9. Epub 2022 Dec 13. PMID: 36513913.
“ These advantages offered by surgical robotic assistance enable safe and efficient operations
even in cases with significant spatial limitations, such as narrow and deep pelvic structures” for
this sentence in discussion you can use following studies  as a references:
Aliyev V, Goksel S, Bakir B, Guven K, Asoglu O. Sphincter-Saving Robotic Total
Mesorectal Excision Provides Better Mesorectal Specimen and Good Oncological Local Control
Compared with Laparoscopic Total Mesorectal Excision in Male Patients with Mid-Low Rectal
Cancer. Surg Technol Int. 2021 May 20;38:160-166. doi: 10.52198/21.STI.38.CR1391. PMID:
33537982.
Aliyev V, Piozzi GN, Huseynov E, Mustafayev TZ, Kayku V, Goksel S, Asoglu O. Robotic
male and laparoscopic female sphincter-preserving total mesorectal excision of mid-low rectal
cancer share similar specimen quality, complication rates and long-term oncological outcomes.
J Robot Surg. 2023 Aug;17(4):1637-1644. doi: 10.1007/s11701-023-01558-2. Epub 2023 Mar
21. PMID: 36943657.
Aliyev V, Piozzi GN, Bulut A, Guven K, Bakir B, Saglam S, Goksel S, Asoglu O. Robotic
vs. laparoscopic intersphincteric resection for low rectal cancer: a case matched study reporting
a median of 7-year long-term oncological and functional outcomes. Updates Surg. 2022
Dec;74(6):1851-1860. doi: 10.1007/s13304-022-01396-1. Epub 2022 Oct 5. PMID: 36198884.
Aliyev V, Piozzi GN, Shadmanov N, Guven K, Bak#r B, Goksel S, Asoglu O. Robotic and
laparoscopic sphincter-saving resections have similar peri-operative, oncological and functional
outcomes in female patients with rectal cancer. Updates Surg. 2023 Dec;75(8):2201-2209. doi:
10.1007/s13304-023-01686-2. Epub 2023 Nov 13. PMID: 37955804.
Aliyev V, Goksoy B, Goksel S, Guven K, Bak#r B, Saglam S, Asoglu O. Intersphincteric
Resection for Low Rectal Cancer: Parameters Affecting Functional Outcomes and Survival
Rates. Surg Technol Int. 2021 Oct 26;39:166-172. doi: 10.52198/21.STI.39.CR1460. PMID:
34699602.
“In recent years, studies reporting on the efficacy of neoadjuvant chemotherapy,
chemoradiotherapy, and neoadjuvant chemotherapy combined with chemoradiotherapy (total
neoadjuvant chemotherapy; TNT) for local control and prognosis improvement of rectal cancer
have been increasing” here you can consider  following studies :
Asoglu O, Goksoy B, Aliyev V, Mustafayev TZ, Atalar B, Bakir B, Guven K, Demir
G, Goksel S. Watch and Wait Strategy for Rectal Cancer: How Long Should We Wait
for a Clinical Complete Response? Surg Technol Int. 2022 May 19;40:130-139. doi:
10.52198/22.STI.40.CR1507. PMID: 35090178.
Asoglu O, Bulut A, Aliyev V, Piozzi GN, Guven K, Bak#r B, Goksel S. Chemoradiation
and consolidation chemotherapy for rectal cancer provides a high rate of organ preservation
with a very good long-term oncological outcome: a single-center cohort series. World J Surg
Oncol. 2022 Nov 10;20(1):358. doi: 10.1186/s12957-022-02816-7. PMID: 36352416; PMCID:
PMC9646475.
Title: Deep pelvis and low visceral fat mass as risk factors for neurogenic bladder after rectal
cancer surgery
Version: 1 Date: 13 Aug 2024
Reviewer's report:
This is an interesting study and well-designed. Authors found  link between the deep pelvic
anatomy and low VFA with postoperative neurogenic bladder. Furthermore, they demonstrated
that both are significantly related with PONB. I have a minor comments:
-what kind of robotic generations are used (da Vinci Si, Xi etc). Because, there also could alter
the operation time due to single/double docking/undocking phases.
-I didn’t find information on method regarding the preop mechanical bowel cleaning or
prophilactic antibiotherapy.
- what kind of CRT (short or long-course) are used, if possible specify in details of names in
method part.
-Are you performing bladder training by  intermittent clamping prior to removal of urinary
catheters after the rectal cancer surgery? Sometimes it may be  helpfull  to prevent urinary
retantion.
-Consider to enrich the references list, as in discussion part there is no cited  some   sentences .
Following studies which directly related with them may be  useful.
“ Many studies have emphasized the importance of measuring pelvic dimensions when planning
rectal cancer surgery to assess surgical difficulty” after this sentence may use this studies, which
conducted on male (narrow pelvis)  patients with distal rectal cancer  (deep pelvis):
Gachabayov M, Felsenreich DM, Bhatti S, Bergamaschi R; RESURRECT Study Group. Does
the visceral fat area impact the histopathology specimen metrics after total mesorectal excision
for distal rectal cancer? Langenbecks Arch Surg. 2023 Jun 30;408(1):257. doi: 10.1007/
s00423-023-02981-7. PMID: 37389686.
Felsenreich DM, Gachabayov M, Bergamaschi R; RESURRECT Study Group. Does the
mesorectal fat area impact the histopathology metrics of the specimen in males undergoing
TME for distal rectal cancer? Updates Surg. 2023 Apr;75(3):581-588. doi: 10.1007/
s13304-022-01429-9. Epub 2022 Dec 13. PMID: 36513913.
“ These advantages offered by surgical robotic assistance enable safe and efficient operations
even in cases with significant spatial limitations, such as narrow and deep pelvic structures” for
this sentence in discussion you can use following studies  as a references:
Aliyev V, Goksel S, Bakir B, Guven K, Asoglu O. Sphincter-Saving Robotic Total
Mesorectal Excision Provides Better Mesorectal Specimen and Good Oncological Local Control
Compared with Laparoscopic Total Mesorectal Excision in Male Patients with Mid-Low Rectal
Cancer. Surg Technol Int. 2021 May 20;38:160-166. doi: 10.52198/21.STI.38.CR1391. PMID:
33537982.
Aliyev V, Piozzi GN, Huseynov E, Mustafayev TZ, Kayku V, Goksel S, Asoglu O. Robotic
male and laparoscopic female sphincter-preserving total mesorectal excision of mid-low rectal
cancer share similar specimen quality, complication rates and long-term oncological outcomes.
J Robot Surg. 2023 Aug;17(4):1637-1644. doi: 10.1007/s11701-023-01558-2. Epub 2023 Mar
21. PMID: 36943657.
Aliyev V, Piozzi GN, Bulut A, Guven K, Bakir B, Saglam S, Goksel S, Asoglu O. Robotic
vs. laparoscopic intersphincteric resection for low rectal cancer: a case matched study reporting
a median of 7-year long-term oncological and functional outcomes. Updates Surg. 2022
Dec;74(6):1851-1860. doi: 10.1007/s13304-022-01396-1. Epub 2022 Oct 5. PMID: 36198884.
Aliyev V, Piozzi GN, Shadmanov N, Guven K, Bak#r B, Goksel S, Asoglu O. Robotic and
laparoscopic sphincter-saving resections have similar peri-operative, oncological and functional
outcomes in female patients with rectal cancer. Updates Surg. 2023 Dec;75(8):2201-2209. doi:
10.1007/s13304-023-01686-2. Epub 2023 Nov 13. PMID: 37955804.
Aliyev V, Goksoy B, Goksel S, Guven K, Bak#r B, Saglam S, Asoglu O. Intersphincteric
Resection for Low Rectal Cancer: Parameters Affecting Functional Outcomes and Survival
Rates. Surg Technol Int. 2021 Oct 26;39:166-172. doi: 10.52198/21.STI.39.CR1460. PMID:
34699602.
“In recent years, studies reporting on the efficacy of neoadjuvant chemotherapy,
chemoradiotherapy, and neoadjuvant chemotherapy combined with chemoradiotherapy (total
neoadjuvant chemotherapy; TNT) for local control and prognosis improvement of rectal cancer
have been increasing” here you can consider  following studies :
Asoglu O, Goksoy B, Aliyev V, Mustafayev TZ, Atalar B, Bakir B, Guven K, Demir
G, Goksel S. Watch and Wait Strategy for Rectal Cancer: How Long Should We Wait
for a Clinical Complete Response? Surg Technol Int. 2022 May 19;40:130-139. doi:
10.52198/22.STI.40.CR1507. PMID: 35090178.
Asoglu O, Bulut A, Aliyev V, Piozzi GN, Guven K, Bak#r B, Goksel S. Chemoradiation
and consolidation chemotherapy for rectal cancer provides a high rate of organ preservation
with a very good long-term oncological outcome: a single-center cohort series. World J Surg
Oncol. 2022 Nov 10;20(1):358. doi: 10.1186/s12957-022-02816-7. PMID: 36352416; PMCID:
PMC9646475.
Please review this paper.
user
Title: Deep pelvis and low visceral fat mass as risk factors for neurogenic bladder after rectal
cancer surgery
Version: 1 Date: 13 Aug 2024
Reviewer's report:
This is an interesting study and well-designed. Authors found  link between the deep pelvic
anatomy and low VFA with postoperative neurogenic bladder. Furthermore, they demonstrated
that both are significantly related with PONB. I have a minor comments:
-what kind of robotic generations are used (da Vinci Si, Xi etc). Because, there also could alter
the operation time due to single/double docking/undocking phases.
-I didn’t find information on method regarding the preop mechanical bowel cleaning or
prophilactic antibiotherapy.
- what kind of CRT (short or long-course) are used, if possible specify in details of names in
method part.
-Are you performing bladder training by  intermittent clamping prior to removal of urinary
catheters after the rectal cancer surgery? Sometimes it may be  helpfull  to prevent urinary
retantion.
-Consider to enrich the references list, as in discussion part there is no cited  some   sentences .
Following studies which directly related with them may be  useful.
“ Many studies have emphasized the importance of measuring pelvic dimensions when planning
rectal cancer surgery to assess surgical difficulty” after this sentence may use this studies, which
conducted on male (narrow pelvis)  patients with distal rectal cancer  (deep pelvis):
Gachabayov M, Felsenreich DM, Bhatti S, Bergamaschi R; RESURRECT Study Group. Does
the visceral fat area impact the histopathology specimen metrics after total mesorectal excision
for distal rectal cancer? Langenbecks Arch Surg. 2023 Jun 30;408(1):257. doi: 10.1007/
s00423-023-02981-7. PMID: 37389686.
Felsenreich DM, Gachabayov M, Bergamaschi R; RESURRECT Study Group. Does the
mesorectal fat area impact the histopathology metrics of the specimen in males undergoing
TME for distal rectal cancer? Updates Surg. 2023 Apr;75(3):581-588. doi: 10.1007/
s13304-022-01429-9. Epub 2022 Dec 13. PMID: 36513913.
“ These advantages offered by surgical robotic assistance enable safe and efficient operations
even in cases with significant spatial limitations, such as narrow and deep pelvic structures” for
this sentence in discussion you can use following studies  as a references:
Aliyev V, Goksel S, Bakir B, Guven K, Asoglu O. Sphincter-Saving Robotic Total
Mesorectal Excision Provides Better Mesorectal Specimen and Good Oncological Local Control
Compared with Laparoscopic Total Mesorectal Excision in Male Patients with Mid-Low Rectal
Cancer. Surg Technol Int. 2021 May 20;38:160-166. doi: 10.52198/21.STI.38.CR1391. PMID:
33537982.
Aliyev V, Piozzi GN, Huseynov E, Mustafayev TZ, Kayku V, Goksel S, Asoglu O. Robotic
male and laparoscopic female sphincter-preserving total mesorectal excision of mid-low rectal
cancer share similar specimen quality, complication rates and long-term oncological outcomes.
J Robot Surg. 2023 Aug;17(4):1637-1644. doi: 10.1007/s11701-023-01558-2. Epub 2023 Mar
21. PMID: 36943657.
Aliyev V, Piozzi GN, Bulut A, Guven K, Bakir B, Saglam S, Goksel S, Asoglu O. Robotic
vs. laparoscopic intersphincteric resection for low rectal cancer: a case matched study reporting
a median of 7-year long-term oncological and functional outcomes. Updates Surg. 2022
Dec;74(6):1851-1860. doi: 10.1007/s13304-022-01396-1. Epub 2022 Oct 5. PMID: 36198884.
Aliyev V, Piozzi GN, Shadmanov N, Guven K, Bak#r B, Goksel S, Asoglu O. Robotic and
laparoscopic sphincter-saving resections have similar peri-operative, oncological and functional
outcomes in female patients with rectal cancer. Updates Surg. 2023 Dec;75(8):2201-2209. doi:
10.1007/s13304-023-01686-2. Epub 2023 Nov 13. PMID: 37955804.
Aliyev V, Goksoy B, Goksel S, Guven K, Bak#r B, Saglam S, Asoglu O. Intersphincteric
Resection for Low Rectal Cancer: Parameters Affecting Functional Outcomes and Survival
Rates. Surg Technol Int. 2021 Oct 26;39:166-172. doi: 10.52198/21.STI.39.CR1460. PMID:
34699602.
“In recent years, studies reporting on the efficacy of neoadjuvant chemotherapy,
chemoradiotherapy, and neoadjuvant chemotherapy combined with chemoradiotherapy (total
neoadjuvant chemotherapy; TNT) for local control and prognosis improvement of rectal cancer
have been increasing” here you can consider  following studies :
Asoglu O, Goksoy B, Aliyev V, Mustafayev TZ, Atalar B, Bakir B, Guven K, Demir
G, Goksel S. Watch and Wait Strategy for Rectal Cancer: How Long Should We Wait
for a Clinical Complete Response? Surg Technol Int. 2022 May 19;40:130-139. doi:
10.52198/22.STI.40.CR1507. PMID: 35090178.
Asoglu O, Bulut A, Aliyev V, Piozzi GN, Guven K, Bak#r B, Goksel S. Chemoradiation
and consolidation chemotherapy for rectal cancer provides a high rate of organ preservation
with a very good long-term oncological outcome: a single-center cohort series. World J Surg
Oncol. 2022 Nov 10;20(1):358. doi: 10.1186/s12957-022-02816-7. PMID: 36352416; PMCID:
PMC9646475.
assistant