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: 20 Jun 2024
Reviewer's report:
It is my pleasure to be invited to review this manuscript. The multiple treatment modalities
and the various sequence of treatments in the current literature means the ideal management
of rectal cancer is still debated. This paper covers another facet of treatment, the lateral lymph
node dissection, that has divided opinion. Further to that, the centre utilises a “sandwich”
chemotherapy regime. I have a few comments:
1. The study mentioned that this study was conducted in 4 centres, and that this study only
discusses the outcomes of a singular centre. Is there a reason for this?
2. The study aimed to include only stage 2/3 patients. Is this based on MRI staging? The pre-
operative stage distribution may be include in the paper.
3. Since the number of patients with recurrence is small, a more in-depth discussion could
be done specific to these cases, describing pre-treatment and post-treatment MRI changes,
subsequent pathological response, resection margin status etc.
4. Due to the small sample size, the risk factors for local recurrence would be difficult to interpret.
The positive factors, including advanced stage, mucinous sub-type and non-R0 resections are
already known risk factors for higher recurrence. Furthermore, other factors including tumour
size and non-sphincter sparing procedures may likely reach statistical significance with a larger
sample size.
5. If the reported outcomes are at 3 years, the graphs provided are drawn up to 5 years. This
could potentially be misleading.
6. It will be good to discuss the types of complications encountered with a LLND in all patients
included in the study. A table of complications, including operative time, conversion rate,
operative blood loss, re-operations, leak rates etc, should be added.
7. The conclusion in the abstract may not be overly certain of this treatment regimen, given that
it is a prospective cohort study with small numbers. The conclusion in the main paper seems
more balanced, although it is not appropriate to conclude that “preoperative chemotherapy and
TME with LLND are sufficient to control local recurrence”.
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: 20 Jun 2024
Reviewer's report:
It is my pleasure to be invited to review this manuscript. The multiple treatment modalities
and the various sequence of treatments in the current literature means the ideal management
of rectal cancer is still debated. This paper covers another facet of treatment, the lateral lymph
node dissection, that has divided opinion. Further to that, the centre utilises a “sandwich”
chemotherapy regime. I have a few comments:
1. The study mentioned that this study was conducted in 4 centres, and that this study only
discusses the outcomes of a singular centre. Is there a reason for this?
2. The study aimed to include only stage 2/3 patients. Is this based on MRI staging? The pre-
operative stage distribution may be include in the paper.
3. Since the number of patients with recurrence is small, a more in-depth discussion could
be done specific to these cases, describing pre-treatment and post-treatment MRI changes,
subsequent pathological response, resection margin status etc.
4. Due to the small sample size, the risk factors for local recurrence would be difficult to interpret.
The positive factors, including advanced stage, mucinous sub-type and non-R0 resections are
already known risk factors for higher recurrence. Furthermore, other factors including tumour
size and non-sphincter sparing procedures may likely reach statistical significance with a larger
sample size.
5. If the reported outcomes are at 3 years, the graphs provided are drawn up to 5 years. This
could potentially be misleading.
6. It will be good to discuss the types of complications encountered with a LLND in all patients
included in the study. A table of complications, including operative time, conversion rate,
operative blood loss, re-operations, leak rates etc, should be added.
7. The conclusion in the abstract may not be overly certain of this treatment regimen, given that
it is a prospective cohort study with small numbers. The conclusion in the main paper seems
more balanced, although it is not appropriate to conclude that “preoperative chemotherapy and
TME with LLND are sufficient to control local recurrence”.
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: 20 Jun 2024
Reviewer's report:
It is my pleasure to be invited to review this manuscript. The multiple treatment modalities
and the various sequence of treatments in the current literature means the ideal management
of rectal cancer is still debated. This paper covers another facet of treatment, the lateral lymph
node dissection, that has divided opinion. Further to that, the centre utilises a “sandwich”
chemotherapy regime. I have a few comments:
1. The study mentioned that this study was conducted in 4 centres, and that this study only
discusses the outcomes of a singular centre. Is there a reason for this?
2. The study aimed to include only stage 2/3 patients. Is this based on MRI staging? The pre-
operative stage distribution may be include in the paper.
3. Since the number of patients with recurrence is small, a more in-depth discussion could
be done specific to these cases, describing pre-treatment and post-treatment MRI changes,
subsequent pathological response, resection margin status etc.
4. Due to the small sample size, the risk factors for local recurrence would be difficult to interpret.
The positive factors, including advanced stage, mucinous sub-type and non-R0 resections are
already known risk factors for higher recurrence. Furthermore, other factors including tumour
size and non-sphincter sparing procedures may likely reach statistical significance with a larger
sample size.
5. If the reported outcomes are at 3 years, the graphs provided are drawn up to 5 years. This
could potentially be misleading.
6. It will be good to discuss the types of complications encountered with a LLND in all patients
included in the study. A table of complications, including operative time, conversion rate,
operative blood loss, re-operations, leak rates etc, should be added.
7. The conclusion in the abstract may not be overly certain of this treatment regimen, given that
it is a prospective cohort study with small numbers. The conclusion in the main paper seems
more balanced, although it is not appropriate to conclude that “preoperative chemotherapy and
TME with LLND are sufficient to control local recurrence”.
assistant