Title: Long-Term Outcomes of S-1 and Oxaliplatin Neoadjuvant Chemotherapy with Total
Mesorectal Excision and Lateral Lymph Node Dissection for Rectal Cancer
Version: 3 Date: 01 Jul 2024
Reviewer's report:
This is an interesting topic concerning lateral lymph node. However, there are several issues
with this article. Firstly, the inclusion criteria do not specify the definition of enlarged lymph
nodes. The indication for lateral lymph node dissection (LLND) is unclear. Increasing evidence
suggests that LLND should be performed when there is suspicion of lateral lymph node
metastasis. It's unclear why the authors routinely perform bilateral lymph node dissection. It
appears that prophylactic LLND is still being performed by the authors. However, substantial
evidence refutes the value of prophylactic LLND in patients without confirmed lateral lymph
node metastasis (J Gastrointest Surg. 2024 Apr;28(4):548-558; Colorectal Dis. 2023;10.1111;
BMC Surg. 2021 May 26;21(1):261.). Even in Japan, the proportion of prophylactic LLND is
decreasing annually (Dis Colon Rectum. 2019 Jun;62(6):e29.). Chinese guidelines explicitly
state that routine prophylactic LLND is not recommended for patients who do not meet
clinical diagnostic criteria for lateral metastasis (Zhonghua Wei Chang Wai Ke Za Zhi. 2024
Jan 25;27(1):1-14.). This study is single-arm and does not compare results with traditional
chemoradiotherapy. Therefore, the study's conclusion that preoperative chemotherapy with total
mesorectal excision (TME) and LLND is beneficial for avoiding radiation-related adverse events
and improving prognosis in rectal cancer lacks rigor. Both the Japanese JCOG1310 study and
Chinese FORWARC study demonstrate that without combined radiotherapy, chemotherapy
alone struggles to control local lateral recurrence (Jpn J Clin Oncol. 2017 Jan;47(1):84-87; Dis
Colon Rectum. 2021 Nov 1;64(11):1321-1330.).
Title: Long-Term Outcomes of S-1 and Oxaliplatin Neoadjuvant Chemotherapy with Total
Mesorectal Excision and Lateral Lymph Node Dissection for Rectal Cancer
Version: 3 Date: 01 Jul 2024
Reviewer's report:
This is an interesting topic concerning lateral lymph node. However, there are several issues
with this article. Firstly, the inclusion criteria do not specify the definition of enlarged lymph
nodes. The indication for lateral lymph node dissection (LLND) is unclear. Increasing evidence
suggests that LLND should be performed when there is suspicion of lateral lymph node
metastasis. It's unclear why the authors routinely perform bilateral lymph node dissection. It
appears that prophylactic LLND is still being performed by the authors. However, substantial
evidence refutes the value of prophylactic LLND in patients without confirmed lateral lymph
node metastasis (J Gastrointest Surg. 2024 Apr;28(4):548-558; Colorectal Dis. 2023;10.1111;
BMC Surg. 2021 May 26;21(1):261.). Even in Japan, the proportion of prophylactic LLND is
decreasing annually (Dis Colon Rectum. 2019 Jun;62(6):e29.). Chinese guidelines explicitly
state that routine prophylactic LLND is not recommended for patients who do not meet
clinical diagnostic criteria for lateral metastasis (Zhonghua Wei Chang Wai Ke Za Zhi. 2024
Jan 25;27(1):1-14.). This study is single-arm and does not compare results with traditional
chemoradiotherapy. Therefore, the study's conclusion that preoperative chemotherapy with total
mesorectal excision (TME) and LLND is beneficial for avoiding radiation-related adverse events
and improving prognosis in rectal cancer lacks rigor. Both the Japanese JCOG1310 study and
Chinese FORWARC study demonstrate that without combined radiotherapy, chemotherapy
alone struggles to control local lateral recurrence (Jpn J Clin Oncol. 2017 Jan;47(1):84-87; Dis
Colon Rectum. 2021 Nov 1;64(11):1321-1330.).
Please review this paper.
user
Title: Long-Term Outcomes of S-1 and Oxaliplatin Neoadjuvant Chemotherapy with Total
Mesorectal Excision and Lateral Lymph Node Dissection for Rectal Cancer
Version: 3 Date: 01 Jul 2024
Reviewer's report:
This is an interesting topic concerning lateral lymph node. However, there are several issues
with this article. Firstly, the inclusion criteria do not specify the definition of enlarged lymph
nodes. The indication for lateral lymph node dissection (LLND) is unclear. Increasing evidence
suggests that LLND should be performed when there is suspicion of lateral lymph node
metastasis. It's unclear why the authors routinely perform bilateral lymph node dissection. It
appears that prophylactic LLND is still being performed by the authors. However, substantial
evidence refutes the value of prophylactic LLND in patients without confirmed lateral lymph
node metastasis (J Gastrointest Surg. 2024 Apr;28(4):548-558; Colorectal Dis. 2023;10.1111;
BMC Surg. 2021 May 26;21(1):261.). Even in Japan, the proportion of prophylactic LLND is
decreasing annually (Dis Colon Rectum. 2019 Jun;62(6):e29.). Chinese guidelines explicitly
state that routine prophylactic LLND is not recommended for patients who do not meet
clinical diagnostic criteria for lateral metastasis (Zhonghua Wei Chang Wai Ke Za Zhi. 2024
Jan 25;27(1):1-14.). This study is single-arm and does not compare results with traditional
chemoradiotherapy. Therefore, the study's conclusion that preoperative chemotherapy with total
mesorectal excision (TME) and LLND is beneficial for avoiding radiation-related adverse events
and improving prognosis in rectal cancer lacks rigor. Both the Japanese JCOG1310 study and
Chinese FORWARC study demonstrate that without combined radiotherapy, chemotherapy
alone struggles to control local lateral recurrence (Jpn J Clin Oncol. 2017 Jan;47(1):84-87; Dis
Colon Rectum. 2021 Nov 1;64(11):1321-1330.).
assistant