Reviewer’s report
Title: 
The effects of preoperative intestinal dysbacteriosis on postoperative
recovery in colorectal cancer surgery: a prospective cohort study
Version: 
1 
Date: 
31 Aug 2021
Reviewer's report:
Many thanks to the authors for their responses, and extensive work on the
presentation of the study. I have some remaining queries.
Most importantly, I still think the current set up of the logistic regression
analysis makes interpretation of the results difficult. 
Methods
I'm a little confused as to how ICD10 codes were used. Was an electronic health
record used to identify potential patients for inclusion? I realise this seems a
minor point but as is this sentence is ambiguous. And for completeness the
ICD10 codes used to identify patients should be stated.
Time from diagnosis to admission was 2-3 weeks - is this a criteria (i.e. patients
were excluded if admission as >3 weeks post diagnosis) or a result? If it is a
result it should be moved to the appropriate section. 
Clinical variables: the one long run on sentence is hard to read. 
Were patients included who had concurrent or previous malignancies? 
Results
The text says co-morbidities were those "diagnosed at admission", how was this
conducted? Was a full patient history review and assessment conducted using
the study report form?
Thank you for your explanation on including early post-operative diarrhea in the
models. In the response there is the comment "most of these events occurred
before the infectious complications." I'd suggest patients where their
complication occurred before their diarrhea should not be included in this model
as they make the interpretation of the model very difficult. 
To clarify - the results in table 4 are for infectious complications or all
complications? This could be stated more clearly.
Language
There are some further minor edits required to the language/writing.
"anastomotic leakage remains one of the most feared complications" I'd argue
this is subjective and would be better presented as an objective comment,
perhaps just by combining this and the next sentence? 
In the introduction, the assumed causes for dysbiosis. It would be better to
provide reference to evidence demonstrating these are feasible links than present
only "assumed causes".
"nearly a quarter of patients upfront surgery" should this perhaps be before,
rather than upfront?
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find the details of processing in Publons’ privacy policy
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Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
The effects of preoperative intestinal dysbacteriosis on postoperative
recovery in colorectal cancer surgery: a prospective cohort study
Version: 
1 
Date: 
31 Aug 2021
Reviewer's report:
Many thanks to the authors for their responses, and extensive work on the
presentation of the study. I have some remaining queries.
Most importantly, I still think the current set up of the logistic regression
analysis makes interpretation of the results difficult. 
Methods
I'm a little confused as to how ICD10 codes were used. Was an electronic health
record used to identify potential patients for inclusion? I realise this seems a
minor point but as is this sentence is ambiguous. And for completeness the
ICD10 codes used to identify patients should be stated.
Time from diagnosis to admission was 2-3 weeks - is this a criteria (i.e. patients
were excluded if admission as >3 weeks post diagnosis) or a result? If it is a
result it should be moved to the appropriate section. 
Clinical variables: the one long run on sentence is hard to read. 
Were patients included who had concurrent or previous malignancies? 
Results
The text says co-morbidities were those "diagnosed at admission", how was this
conducted? Was a full patient history review and assessment conducted using
the study report form?
Thank you for your explanation on including early post-operative diarrhea in the
models. In the response there is the comment "most of these events occurred
before the infectious complications." I'd suggest patients where their
complication occurred before their diarrhea should not be included in this model
as they make the interpretation of the model very difficult. 
To clarify - the results in table 4 are for infectious complications or all
complications? This could be stated more clearly.
Language
There are some further minor edits required to the language/writing.
"anastomotic leakage remains one of the most feared complications" I'd argue
this is subjective and would be better presented as an objective comment,
perhaps just by combining this and the next sentence? 
In the introduction, the assumed causes for dysbiosis. It would be better to
provide reference to evidence demonstrating these are feasible links than present
only "assumed causes".
"nearly a quarter of patients upfront surgery" should this perhaps be before,
rather than upfront?
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
The effects of preoperative intestinal dysbacteriosis on postoperative
recovery in colorectal cancer surgery: a prospective cohort study
Version: 
1 
Date: 
31 Aug 2021
Reviewer's report:
Many thanks to the authors for their responses, and extensive work on the
presentation of the study. I have some remaining queries.
Most importantly, I still think the current set up of the logistic regression
analysis makes interpretation of the results difficult. 
Methods
I'm a little confused as to how ICD10 codes were used. Was an electronic health
record used to identify potential patients for inclusion? I realise this seems a
minor point but as is this sentence is ambiguous. And for completeness the
ICD10 codes used to identify patients should be stated.
Time from diagnosis to admission was 2-3 weeks - is this a criteria (i.e. patients
were excluded if admission as >3 weeks post diagnosis) or a result? If it is a
result it should be moved to the appropriate section. 
Clinical variables: the one long run on sentence is hard to read. 
Were patients included who had concurrent or previous malignancies? 
Results
The text says co-morbidities were those "diagnosed at admission", how was this
conducted? Was a full patient history review and assessment conducted using
the study report form?
Thank you for your explanation on including early post-operative diarrhea in the
models. In the response there is the comment "most of these events occurred
before the infectious complications." I'd suggest patients where their
complication occurred before their diarrhea should not be included in this model
as they make the interpretation of the model very difficult. 
To clarify - the results in table 4 are for infectious complications or all
complications? This could be stated more clearly.
Language
There are some further minor edits required to the language/writing.
"anastomotic leakage remains one of the most feared complications" I'd argue
this is subjective and would be better presented as an objective comment,
perhaps just by combining this and the next sentence? 
In the introduction, the assumed causes for dysbiosis. It would be better to
provide reference to evidence demonstrating these are feasible links than present
only "assumed causes".
"nearly a quarter of patients upfront surgery" should this perhaps be before,
rather than upfront?
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant