Title: Risk factors of additional surgery after non-curative endoscopic submucosal dissection
for early gastric cancer
Version: 1 Date: 18 Aug 2023
Reviewer's report:
the authors performed a retrospective analysis of 133 patients operated following an ESD for
an eCura  B or C early gastric cancer.
My comments are the following :
The study lacks originality, since multiple larger reports on the topic have been published in
Japan, Korea and US. However, the present study be of interest provided additional data is added.
1. The occurence of metastases in the follow up period ( and the follow-up duration) is of
paramount importance : if most patients with LNM present cancer recurrence, than the benefit
of the surgery is questionable.
2. Please condiser adding the morbidity and the mortality o the surgery.
3. Data in the colon indicate that the depth of submucosal invasion is not a significant
independant predictor of LNM. Please add the comparison of  the rates of LNM among T1 a,
T1b sm1 and T1b sm2 tumors  in the table 3.
4. Taking the study findings into account, the lymphatic invasion rate is the best predictor of
LNM. Please add a table indicating, for each of the 14 patients with LNM, what where the poor
histoprognostic factors involved. Please add  in the discussion a comment, specifiying how many
of the 14 patients with LNM would have been picked up using only the L+, V+ criteria ? the
vertical R1  criterion ? the Mixed histological type criterion ?
5.Although not confirmed by the multivariate analysis,  the higher prevalence of LNM with
mixed histological type than with undifferentiated type is a remarkable finding. You briefly
refer to different carcinogenesis mechanism : please elaborate in the discussion on possible
explanations for this more aggressive tumor behavior.
6. Small typos remain in the paper, like "ecure" or "cardiac and bottom" and need to be corrected
Title: Risk factors of additional surgery after non-curative endoscopic submucosal dissection
for early gastric cancer
Version: 1 Date: 18 Aug 2023
Reviewer's report:
the authors performed a retrospective analysis of 133 patients operated following an ESD for
an eCura  B or C early gastric cancer.
My comments are the following :
The study lacks originality, since multiple larger reports on the topic have been published in
Japan, Korea and US. However, the present study be of interest provided additional data is added.
1. The occurence of metastases in the follow up period ( and the follow-up duration) is of
paramount importance : if most patients with LNM present cancer recurrence, than the benefit
of the surgery is questionable.
2. Please condiser adding the morbidity and the mortality o the surgery.
3. Data in the colon indicate that the depth of submucosal invasion is not a significant
independant predictor of LNM. Please add the comparison of  the rates of LNM among T1 a,
T1b sm1 and T1b sm2 tumors  in the table 3.
4. Taking the study findings into account, the lymphatic invasion rate is the best predictor of
LNM. Please add a table indicating, for each of the 14 patients with LNM, what where the poor
histoprognostic factors involved. Please add  in the discussion a comment, specifiying how many
of the 14 patients with LNM would have been picked up using only the L+, V+ criteria ? the
vertical R1  criterion ? the Mixed histological type criterion ?
5.Although not confirmed by the multivariate analysis,  the higher prevalence of LNM with
mixed histological type than with undifferentiated type is a remarkable finding. You briefly
refer to different carcinogenesis mechanism : please elaborate in the discussion on possible
explanations for this more aggressive tumor behavior.
6. Small typos remain in the paper, like "ecure" or "cardiac and bottom" and need to be corrected
Please review this paper.
user
Title: Risk factors of additional surgery after non-curative endoscopic submucosal dissection
for early gastric cancer
Version: 1 Date: 18 Aug 2023
Reviewer's report:
the authors performed a retrospective analysis of 133 patients operated following an ESD for
an eCura  B or C early gastric cancer.
My comments are the following :
The study lacks originality, since multiple larger reports on the topic have been published in
Japan, Korea and US. However, the present study be of interest provided additional data is added.
1. The occurence of metastases in the follow up period ( and the follow-up duration) is of
paramount importance : if most patients with LNM present cancer recurrence, than the benefit
of the surgery is questionable.
2. Please condiser adding the morbidity and the mortality o the surgery.
3. Data in the colon indicate that the depth of submucosal invasion is not a significant
independant predictor of LNM. Please add the comparison of  the rates of LNM among T1 a,
T1b sm1 and T1b sm2 tumors  in the table 3.
4. Taking the study findings into account, the lymphatic invasion rate is the best predictor of
LNM. Please add a table indicating, for each of the 14 patients with LNM, what where the poor
histoprognostic factors involved. Please add  in the discussion a comment, specifiying how many
of the 14 patients with LNM would have been picked up using only the L+, V+ criteria ? the
vertical R1  criterion ? the Mixed histological type criterion ?
5.Although not confirmed by the multivariate analysis,  the higher prevalence of LNM with
mixed histological type than with undifferentiated type is a remarkable finding. You briefly
refer to different carcinogenesis mechanism : please elaborate in the discussion on possible
explanations for this more aggressive tumor behavior.
6. Small typos remain in the paper, like "ecure" or "cardiac and bottom" and need to be corrected
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