Title: Long-term prognosis after endoscopic submucosal dissection for esophageal cancer in
older adult patients
Version: 1 Date: 03 Mar 2024
Reviewer's report:
This study demonstrates the benefit and safety of endoscopic resection of ESCC in the elderly.
It is also very useful in suggesting the pros and cons of additional treatment in the case of
noncurative resection.
However, there are some modifications that need to be made, so please answer the following
questions.
Major comments
1. It is noteworthy that in the present study there was no difference in survival in elderly ESCC
patients with ASA 3 or higher, with or without additional treatment. However, it would be an
over-interpretation to argue the need for additional treatment based on the results of this study. It
is well known that many ESCC patients are smokers and heavy drinkers, and that they often have
overlapping cancers of other organs, such as pharyngeal cancer, lung cancer, and bladder cancer.
In fact, in the present study, deaths from cancer of other organs were the most common cause
of death. In this regard, it is important to ask whether the patients in this study were screened
for complications of cancer of other organs prior to the start of treatment. Please provide your
response to this question.
2. Immunostaining is recommended to determine the presence of vascular invasion
pathologically; it may have been difficult to determine the presence of vascular invasion in
the patients treated before 2013. In what year were the patients with T1a-EP who developed
metastatic recurrence in the cervix treated in this study? Please state your answer.
3. The most noteworthy result of this study concerns treatment strategies for elderly patients
with poor ADL. It has been reported that the concept of sarcopenia related to muscle mass is
useful as a prognostic factor in the elderly. In the current study, sarcopenia (e.g., SARC-F, etc.)
was not assessed. Please state the reason.
Minor comments
1. Perforation related to ESD in this study occurred in 19 cases (4%). This may be higher than the
incidence of perforation, a common complication. If there is a reason for this, please describe it.
2. On page 5 of the text, lines 6-7, "For patient with ..." should be stated as "ESD procedure".
Title: Long-term prognosis after endoscopic submucosal dissection for esophageal cancer in
older adult patients
Version: 1 Date: 03 Mar 2024
Reviewer's report:
This study demonstrates the benefit and safety of endoscopic resection of ESCC in the elderly.
It is also very useful in suggesting the pros and cons of additional treatment in the case of
noncurative resection.
However, there are some modifications that need to be made, so please answer the following
questions.
Major comments
1. It is noteworthy that in the present study there was no difference in survival in elderly ESCC
patients with ASA 3 or higher, with or without additional treatment. However, it would be an
over-interpretation to argue the need for additional treatment based on the results of this study. It
is well known that many ESCC patients are smokers and heavy drinkers, and that they often have
overlapping cancers of other organs, such as pharyngeal cancer, lung cancer, and bladder cancer.
In fact, in the present study, deaths from cancer of other organs were the most common cause
of death. In this regard, it is important to ask whether the patients in this study were screened
for complications of cancer of other organs prior to the start of treatment. Please provide your
response to this question.
2. Immunostaining is recommended to determine the presence of vascular invasion
pathologically; it may have been difficult to determine the presence of vascular invasion in
the patients treated before 2013. In what year were the patients with T1a-EP who developed
metastatic recurrence in the cervix treated in this study? Please state your answer.
3. The most noteworthy result of this study concerns treatment strategies for elderly patients
with poor ADL. It has been reported that the concept of sarcopenia related to muscle mass is
useful as a prognostic factor in the elderly. In the current study, sarcopenia (e.g., SARC-F, etc.)
was not assessed. Please state the reason.
Minor comments
1. Perforation related to ESD in this study occurred in 19 cases (4%). This may be higher than the
incidence of perforation, a common complication. If there is a reason for this, please describe it.
2. On page 5 of the text, lines 6-7, "For patient with ..." should be stated as "ESD procedure".
Please review this paper.
user
Title: Long-term prognosis after endoscopic submucosal dissection for esophageal cancer in
older adult patients
Version: 1 Date: 03 Mar 2024
Reviewer's report:
This study demonstrates the benefit and safety of endoscopic resection of ESCC in the elderly.
It is also very useful in suggesting the pros and cons of additional treatment in the case of
noncurative resection.
However, there are some modifications that need to be made, so please answer the following
questions.
Major comments
1. It is noteworthy that in the present study there was no difference in survival in elderly ESCC
patients with ASA 3 or higher, with or without additional treatment. However, it would be an
over-interpretation to argue the need for additional treatment based on the results of this study. It
is well known that many ESCC patients are smokers and heavy drinkers, and that they often have
overlapping cancers of other organs, such as pharyngeal cancer, lung cancer, and bladder cancer.
In fact, in the present study, deaths from cancer of other organs were the most common cause
of death. In this regard, it is important to ask whether the patients in this study were screened
for complications of cancer of other organs prior to the start of treatment. Please provide your
response to this question.
2. Immunostaining is recommended to determine the presence of vascular invasion
pathologically; it may have been difficult to determine the presence of vascular invasion in
the patients treated before 2013. In what year were the patients with T1a-EP who developed
metastatic recurrence in the cervix treated in this study? Please state your answer.
3. The most noteworthy result of this study concerns treatment strategies for elderly patients
with poor ADL. It has been reported that the concept of sarcopenia related to muscle mass is
useful as a prognostic factor in the elderly. In the current study, sarcopenia (e.g., SARC-F, etc.)
was not assessed. Please state the reason.
Minor comments
1. Perforation related to ESD in this study occurred in 19 cases (4%). This may be higher than the
incidence of perforation, a common complication. If there is a reason for this, please describe it.
2. On page 5 of the text, lines 6-7, "For patient with ..." should be stated as "ESD procedure".
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