Title: Resection of the Primary Tumor Improves the Prognosis of Gastrointestinal
Neuroendocrine Neoplasms with liver metastases: Mutual Validation based on SEER Database
and Institutional Data
Version: 1 Date: 22 Sep 2023
Reviewer's report:
The paper analyzes an interesting topic, however some issues need to be addressed.
- The introduction as well as the discussion should be improved by adding more data that
highlight the need and the benefit of primary tumor resection also in the metatastic site.  This
is particularly true for GI NETs as  limiting the disease to the liver allows several potentially
curative treatment options, including liver resection or liver transplant. Of note, the resection of
the primary tumor reduces the risk of local complication, particularly in the case of small-bowel
NENs, such as occlusion, perforation and/or bleeding. Please refer to "Citterio, D.; Pusceddu,
S.; Facciorusso, A.; Coppa, J.; Milione, M.; Buzzoni, R.; Bongini, M.; Debraud, F.; Mazzaferro,
V. Primary
tumour resection may improve survival in functional well-differentiated neuroendocrine
tumours metastatic to the liver. Eur. J. Surg. Oncol. 2017, 43, 380–387".  On the other hand,
it is important to highlight that the benefit of primary tumor resection in metastastic pancreatic
nets is less clear.
Furthermore, in uknown primary origin NEN, the search for the primary tumor is warranted
as the resection of the primary tumor improves survival: please refer to "Rossi RE et al.
Multidisciplinary Approach to the Diagnosis of Occult Primary
Neuroendocrine Neoplasm: A Clinical Challenge. JCM 2023"
- Results: "Subgroup analysis demonstrated that PTR was associated with better prognosis
in patients aged 55 or older, those with colorectal primaries, T1 stage, and those without
extrahepatic metastasis". Please comment these results? Why do the authors think that the better
prognosis was observed in colo-rectal primaries rather than in small bowel primaries, which are
generally the majority?
- English language need to be properly checked by a mother tongue
- There are several ypo and grammar mistakes to be edited. Some examples:
- line 39 gastrointestinal please use GI
- line 162, our please do not use the capital letter
- line 193 our please use the capital letter
Title: Resection of the Primary Tumor Improves the Prognosis of Gastrointestinal
Neuroendocrine Neoplasms with liver metastases: Mutual Validation based on SEER Database
and Institutional Data
Version: 1 Date: 22 Sep 2023
Reviewer's report:
The paper analyzes an interesting topic, however some issues need to be addressed.
- The introduction as well as the discussion should be improved by adding more data that
highlight the need and the benefit of primary tumor resection also in the metatastic site.  This
is particularly true for GI NETs as  limiting the disease to the liver allows several potentially
curative treatment options, including liver resection or liver transplant. Of note, the resection of
the primary tumor reduces the risk of local complication, particularly in the case of small-bowel
NENs, such as occlusion, perforation and/or bleeding. Please refer to "Citterio, D.; Pusceddu,
S.; Facciorusso, A.; Coppa, J.; Milione, M.; Buzzoni, R.; Bongini, M.; Debraud, F.; Mazzaferro,
V. Primary
tumour resection may improve survival in functional well-differentiated neuroendocrine
tumours metastatic to the liver. Eur. J. Surg. Oncol. 2017, 43, 380–387".  On the other hand,
it is important to highlight that the benefit of primary tumor resection in metastastic pancreatic
nets is less clear.
Furthermore, in uknown primary origin NEN, the search for the primary tumor is warranted
as the resection of the primary tumor improves survival: please refer to "Rossi RE et al.
Multidisciplinary Approach to the Diagnosis of Occult Primary
Neuroendocrine Neoplasm: A Clinical Challenge. JCM 2023"
- Results: "Subgroup analysis demonstrated that PTR was associated with better prognosis
in patients aged 55 or older, those with colorectal primaries, T1 stage, and those without
extrahepatic metastasis". Please comment these results? Why do the authors think that the better
prognosis was observed in colo-rectal primaries rather than in small bowel primaries, which are
generally the majority?
- English language need to be properly checked by a mother tongue
- There are several ypo and grammar mistakes to be edited. Some examples:
- line 39 gastrointestinal please use GI
- line 162, our please do not use the capital letter
- line 193 our please use the capital letter
Please review this paper.
user
Title: Resection of the Primary Tumor Improves the Prognosis of Gastrointestinal
Neuroendocrine Neoplasms with liver metastases: Mutual Validation based on SEER Database
and Institutional Data
Version: 1 Date: 22 Sep 2023
Reviewer's report:
The paper analyzes an interesting topic, however some issues need to be addressed.
- The introduction as well as the discussion should be improved by adding more data that
highlight the need and the benefit of primary tumor resection also in the metatastic site.  This
is particularly true for GI NETs as  limiting the disease to the liver allows several potentially
curative treatment options, including liver resection or liver transplant. Of note, the resection of
the primary tumor reduces the risk of local complication, particularly in the case of small-bowel
NENs, such as occlusion, perforation and/or bleeding. Please refer to "Citterio, D.; Pusceddu,
S.; Facciorusso, A.; Coppa, J.; Milione, M.; Buzzoni, R.; Bongini, M.; Debraud, F.; Mazzaferro,
V. Primary
tumour resection may improve survival in functional well-differentiated neuroendocrine
tumours metastatic to the liver. Eur. J. Surg. Oncol. 2017, 43, 380–387".  On the other hand,
it is important to highlight that the benefit of primary tumor resection in metastastic pancreatic
nets is less clear.
Furthermore, in uknown primary origin NEN, the search for the primary tumor is warranted
as the resection of the primary tumor improves survival: please refer to "Rossi RE et al.
Multidisciplinary Approach to the Diagnosis of Occult Primary
Neuroendocrine Neoplasm: A Clinical Challenge. JCM 2023"
- Results: "Subgroup analysis demonstrated that PTR was associated with better prognosis
in patients aged 55 or older, those with colorectal primaries, T1 stage, and those without
extrahepatic metastasis". Please comment these results? Why do the authors think that the better
prognosis was observed in colo-rectal primaries rather than in small bowel primaries, which are
generally the majority?
- English language need to be properly checked by a mother tongue
- There are several ypo and grammar mistakes to be edited. Some examples:
- line 39 gastrointestinal please use GI
- line 162, our please do not use the capital letter
- line 193 our please use the capital letter
assistant