Title: Limited wedge resection for T1 colon cancer (LIMERIC-II trial) – rationale and study
protocol of a prospective multicenter clinical trial
Version: 2 Date: 22 May 2023
Reviewer:  Kinichi Hotta
Reviewer's report:
Hanevelt and their colleagues submitted a protocol paper entitled” Limited wedge resection for
T1 colon cancer (LIMERIC-II trial) – rationale and study protocol of a prospective multicenter
clinical trial”. Colonoscopy-Assisted Laparoscopic Wedge Resection (CAL-WR) has been
reported from same group as a novel treatment method for deep submucosal invasive colon
carcinomas (T1 CCs). This multicenter prospective study seems to be interesting and promising.
I'm very curious to know how large a lesion can be resected with this method.  I have some
concerns about this manuscript as follows.
Major comments
1# In abstract, actual sample size should will be included.
2# In method section (Page 5, Line 83), they mentioned about Hiroshima C1-3, but I did not
found a reference about this classification and Hiroshima C1 included approximately 50%
adenoma cases. Is it best to use Hiroshima C1 for (T1 CCs)?
3# In method section, size < 40mm is one of inclusion criteria. How do you measure lesion size
in this study? Do you use some kind of measuring devises? Please clarify it.
4# Distant metastasis at baseline is one of the exclusion criteria. Do you carry out CT scans
before inclusion for all cases? Please clarify it.
5# Is there no need for an exclusion criterion for surgical tolerance?
6# In study design section (page 6, Line 112) they described about recommendation of local
resection strategies (ESD, eFTR or CAL-WR). Please clarify indications about ESD in this study
group.
Minor comments
1) In quality assurance section (Page 7, Line 136), they mentioned close up images. Do you
mean use of magnified endoscopy in all institutions?
2) Please correct Kayama to Koyama (Page 7. Line 140).
Title: Limited wedge resection for T1 colon cancer (LIMERIC-II trial) – rationale and study
protocol of a prospective multicenter clinical trial
Version: 2 Date: 22 May 2023
Reviewer:  Kinichi Hotta
Reviewer's report:
Hanevelt and their colleagues submitted a protocol paper entitled” Limited wedge resection for
T1 colon cancer (LIMERIC-II trial) – rationale and study protocol of a prospective multicenter
clinical trial”. Colonoscopy-Assisted Laparoscopic Wedge Resection (CAL-WR) has been
reported from same group as a novel treatment method for deep submucosal invasive colon
carcinomas (T1 CCs). This multicenter prospective study seems to be interesting and promising.
I'm very curious to know how large a lesion can be resected with this method.  I have some
concerns about this manuscript as follows.
Major comments
1# In abstract, actual sample size should will be included.
2# In method section (Page 5, Line 83), they mentioned about Hiroshima C1-3, but I did not
found a reference about this classification and Hiroshima C1 included approximately 50%
adenoma cases. Is it best to use Hiroshima C1 for (T1 CCs)?
3# In method section, size < 40mm is one of inclusion criteria. How do you measure lesion size
in this study? Do you use some kind of measuring devises? Please clarify it.
4# Distant metastasis at baseline is one of the exclusion criteria. Do you carry out CT scans
before inclusion for all cases? Please clarify it.
5# Is there no need for an exclusion criterion for surgical tolerance?
6# In study design section (page 6, Line 112) they described about recommendation of local
resection strategies (ESD, eFTR or CAL-WR). Please clarify indications about ESD in this study
group.
Minor comments
1) In quality assurance section (Page 7, Line 136), they mentioned close up images. Do you
mean use of magnified endoscopy in all institutions?
2) Please correct Kayama to Koyama (Page 7. Line 140).
Please review this paper.
user
Title: Limited wedge resection for T1 colon cancer (LIMERIC-II trial) – rationale and study
protocol of a prospective multicenter clinical trial
Version: 2 Date: 22 May 2023
Reviewer:  Kinichi Hotta
Reviewer's report:
Hanevelt and their colleagues submitted a protocol paper entitled” Limited wedge resection for
T1 colon cancer (LIMERIC-II trial) – rationale and study protocol of a prospective multicenter
clinical trial”. Colonoscopy-Assisted Laparoscopic Wedge Resection (CAL-WR) has been
reported from same group as a novel treatment method for deep submucosal invasive colon
carcinomas (T1 CCs). This multicenter prospective study seems to be interesting and promising.
I'm very curious to know how large a lesion can be resected with this method.  I have some
concerns about this manuscript as follows.
Major comments
1# In abstract, actual sample size should will be included.
2# In method section (Page 5, Line 83), they mentioned about Hiroshima C1-3, but I did not
found a reference about this classification and Hiroshima C1 included approximately 50%
adenoma cases. Is it best to use Hiroshima C1 for (T1 CCs)?
3# In method section, size < 40mm is one of inclusion criteria. How do you measure lesion size
in this study? Do you use some kind of measuring devises? Please clarify it.
4# Distant metastasis at baseline is one of the exclusion criteria. Do you carry out CT scans
before inclusion for all cases? Please clarify it.
5# Is there no need for an exclusion criterion for surgical tolerance?
6# In study design section (page 6, Line 112) they described about recommendation of local
resection strategies (ESD, eFTR or CAL-WR). Please clarify indications about ESD in this study
group.
Minor comments
1) In quality assurance section (Page 7, Line 136), they mentioned close up images. Do you
mean use of magnified endoscopy in all institutions?
2) Please correct Kayama to Koyama (Page 7. Line 140).
assistant