Title: Comparison of Prognostic Outcomes between Endoscopic Submucosal Dissection and
Surgical Treatment for Early Gastric Cancer: A Retrospective Cohort Study
Version: 1 Date: 24 Nov 2023
Reviewer:  Kohei Yamanouchi
Reviewer's report:
Comments to the Author
I enjoyed reading this retrospective cohort study entitled “Comparison of Prognostic Outcomes
between Endoscopic Submucosal Dissection and Surgical Treatment for Early Gastric Cancer:
A Retrospective Cohort Study”.
Furthermore, the following comments should be addressed.
1. The authors indicated over all survival and recurrence-free survival in Figure 2. However,
both rates are considerably lower than those reported in previous studies. This may be due to
the effect of death from non-gastric cancer caused by the patient's underlying disease.
2. Related to question 1, over all survival is low in both the ESD and surgery groups, despite
the inclusion of many patients younger than 60 years and ASA-PS grade I patients. What do the
authors think about this point?
3. It seems somewhat unlikely that there is little difference in baseline characteristics between
patients in the ESD and surgery groups. In the choice of treatment, there usually seems to be a
difference in procedural difficulty, factors related to recurrence (tumor diameter, location, tumor
differentiation, presence of ulceration, etc.) and patient background (age, ASA-PS). How would
you interpret this?
4. In Table 1, the percentage of intramucosal lesions in the ESD group appears to be low. Is this
because the indications for ESD for early gastric cancer are widely defined? I think it should be
noted what percentage of patients are considered to have an indication for ESD or an extended
indication for ESD based on the preoperative diagnosis.
5. In Table 3, the authors use recurrence-free survival (RFS) to evaluate prognostic factors,
but considering that the number of non-gastric cancer deaths would be quite high, it may be
preferable to use disease-specific survival rather than RFS.
6. In this study, were there any cases that were pathologically diagnosed as non-curative
resection after ESD and subsequently incorporated into the surgical group? Or were most of
the patients who had non-curative resection after ESD to be followed up without additional
gastrectomy?
7. In the Materials and methods section, the description of hemostasis in surgery is noticeably
repetitive and should be simplified.
8. The differentiation of gastric cancer is mixed between "high" and "well", so please unify the
description.
Title: Comparison of Prognostic Outcomes between Endoscopic Submucosal Dissection and
Surgical Treatment for Early Gastric Cancer: A Retrospective Cohort Study
Version: 1 Date: 24 Nov 2023
Reviewer:  Kohei Yamanouchi
Reviewer's report:
Comments to the Author
I enjoyed reading this retrospective cohort study entitled “Comparison of Prognostic Outcomes
between Endoscopic Submucosal Dissection and Surgical Treatment for Early Gastric Cancer:
A Retrospective Cohort Study”.
Furthermore, the following comments should be addressed.
1. The authors indicated over all survival and recurrence-free survival in Figure 2. However,
both rates are considerably lower than those reported in previous studies. This may be due to
the effect of death from non-gastric cancer caused by the patient's underlying disease.
2. Related to question 1, over all survival is low in both the ESD and surgery groups, despite
the inclusion of many patients younger than 60 years and ASA-PS grade I patients. What do the
authors think about this point?
3. It seems somewhat unlikely that there is little difference in baseline characteristics between
patients in the ESD and surgery groups. In the choice of treatment, there usually seems to be a
difference in procedural difficulty, factors related to recurrence (tumor diameter, location, tumor
differentiation, presence of ulceration, etc.) and patient background (age, ASA-PS). How would
you interpret this?
4. In Table 1, the percentage of intramucosal lesions in the ESD group appears to be low. Is this
because the indications for ESD for early gastric cancer are widely defined? I think it should be
noted what percentage of patients are considered to have an indication for ESD or an extended
indication for ESD based on the preoperative diagnosis.
5. In Table 3, the authors use recurrence-free survival (RFS) to evaluate prognostic factors,
but considering that the number of non-gastric cancer deaths would be quite high, it may be
preferable to use disease-specific survival rather than RFS.
6. In this study, were there any cases that were pathologically diagnosed as non-curative
resection after ESD and subsequently incorporated into the surgical group? Or were most of
the patients who had non-curative resection after ESD to be followed up without additional
gastrectomy?
7. In the Materials and methods section, the description of hemostasis in surgery is noticeably
repetitive and should be simplified.
8. The differentiation of gastric cancer is mixed between "high" and "well", so please unify the
description.
Please review this paper.
user
Title: Comparison of Prognostic Outcomes between Endoscopic Submucosal Dissection and
Surgical Treatment for Early Gastric Cancer: A Retrospective Cohort Study
Version: 1 Date: 24 Nov 2023
Reviewer:  Kohei Yamanouchi
Reviewer's report:
Comments to the Author
I enjoyed reading this retrospective cohort study entitled “Comparison of Prognostic Outcomes
between Endoscopic Submucosal Dissection and Surgical Treatment for Early Gastric Cancer:
A Retrospective Cohort Study”.
Furthermore, the following comments should be addressed.
1. The authors indicated over all survival and recurrence-free survival in Figure 2. However,
both rates are considerably lower than those reported in previous studies. This may be due to
the effect of death from non-gastric cancer caused by the patient's underlying disease.
2. Related to question 1, over all survival is low in both the ESD and surgery groups, despite
the inclusion of many patients younger than 60 years and ASA-PS grade I patients. What do the
authors think about this point?
3. It seems somewhat unlikely that there is little difference in baseline characteristics between
patients in the ESD and surgery groups. In the choice of treatment, there usually seems to be a
difference in procedural difficulty, factors related to recurrence (tumor diameter, location, tumor
differentiation, presence of ulceration, etc.) and patient background (age, ASA-PS). How would
you interpret this?
4. In Table 1, the percentage of intramucosal lesions in the ESD group appears to be low. Is this
because the indications for ESD for early gastric cancer are widely defined? I think it should be
noted what percentage of patients are considered to have an indication for ESD or an extended
indication for ESD based on the preoperative diagnosis.
5. In Table 3, the authors use recurrence-free survival (RFS) to evaluate prognostic factors,
but considering that the number of non-gastric cancer deaths would be quite high, it may be
preferable to use disease-specific survival rather than RFS.
6. In this study, were there any cases that were pathologically diagnosed as non-curative
resection after ESD and subsequently incorporated into the surgical group? Or were most of
the patients who had non-curative resection after ESD to be followed up without additional
gastrectomy?
7. In the Materials and methods section, the description of hemostasis in surgery is noticeably
repetitive and should be simplified.
8. The differentiation of gastric cancer is mixed between "high" and "well", so please unify the
description.
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