Reviewer’s report
Title: 
Determining the survival benefit of postoperative radiotherapy in patients
with pT1-3N1M0 rectal cancer undergoing total mesorectal excision: a
retrospective analysis
Version: 
0 
Date: 
30 Jul 2022
Reviewer's report:
The authors of the study revealed that for rectal cancer pT1-3N1M0 operated on
without neodjuvant treatment not always postoperative radiotherapy is necessary.
They found that only in tumours larger that 50mm and when there were 3
positive lymph nodes in the specimen postoperative radiotherapy is associated
with survival benefit. The analysed data from SEER database and performed
propensity score matching to eliminate the influence of possible confounders
differently distributed in analysed groups. 
The study is interesting as after introduction of TME the rate of local recurrences
diminished significantly. Still some studies, i.e. Dutch TME trial, emphasised the
value of radiotherapy as neoadjuvant treatment. The statistical analysis is
performed and explained properly.
There are some issues that should be addressed before publication:
1) There are may censored observations in all survival curves, even when only 5
year follow-up is taken into consideration. The authors should specify what was
the actual median follow-up of the analysed patients and how many patients
were lost to follow-up. With so many censored observation the data might be not
reliable when survival is analysed. 
2) Introduction - The abbreviation should be LARC not LAGC
3) The authors stated that high quality of TME is necessary to achieve optimal
oncological results without postoperative radiotherapy. On the other hand, they
wrote in the discussion that the quality of rectal specimen was unknown in the
study. This is inconsistent. Analysed patients were operated on between 2004
and 2016 so the quality of surgery may be different during 12 years. 
4) Results section - the authors stated that all patients had underwent radical
surgery. Please specify whether only R0 patients were included or R1 as well?
5) Discussion - the authors stated that radiotherapy impaired anal function and
voiding but did not mention that this complication may be the results of surgery
and sacral nerves injury not radiotherapy only.
6) Discussion - the abbreviation LPLN should be explained. 
7) Discussion - the word mesentery should be changed into mesorectum in the
sentence "Smooth and intact mesentery"
8) Introduction - the authors cite NCCN guidelines but they did not comment
total neoadjuvant treatment (TNT) that is included in the current NCC guidelines
and more and more commonly adopted clinical practice. At least a couple os
sentences on this issue should be added to discussion with speculation whether
only adjuvant chemotherapy may be better that TNT?
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find the details of processing in Publons’ privacy policy
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Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare no competing interests.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Determining the survival benefit of postoperative radiotherapy in patients
with pT1-3N1M0 rectal cancer undergoing total mesorectal excision: a
retrospective analysis
Version: 
0 
Date: 
30 Jul 2022
Reviewer's report:
The authors of the study revealed that for rectal cancer pT1-3N1M0 operated on
without neodjuvant treatment not always postoperative radiotherapy is necessary.
They found that only in tumours larger that 50mm and when there were 3
positive lymph nodes in the specimen postoperative radiotherapy is associated
with survival benefit. The analysed data from SEER database and performed
propensity score matching to eliminate the influence of possible confounders
differently distributed in analysed groups. 
The study is interesting as after introduction of TME the rate of local recurrences
diminished significantly. Still some studies, i.e. Dutch TME trial, emphasised the
value of radiotherapy as neoadjuvant treatment. The statistical analysis is
performed and explained properly.
There are some issues that should be addressed before publication:
1) There are may censored observations in all survival curves, even when only 5
year follow-up is taken into consideration. The authors should specify what was
the actual median follow-up of the analysed patients and how many patients
were lost to follow-up. With so many censored observation the data might be not
reliable when survival is analysed. 
2) Introduction - The abbreviation should be LARC not LAGC
3) The authors stated that high quality of TME is necessary to achieve optimal
oncological results without postoperative radiotherapy. On the other hand, they
wrote in the discussion that the quality of rectal specimen was unknown in the
study. This is inconsistent. Analysed patients were operated on between 2004
and 2016 so the quality of surgery may be different during 12 years. 
4) Results section - the authors stated that all patients had underwent radical
surgery. Please specify whether only R0 patients were included or R1 as well?
5) Discussion - the authors stated that radiotherapy impaired anal function and
voiding but did not mention that this complication may be the results of surgery
and sacral nerves injury not radiotherapy only.
6) Discussion - the abbreviation LPLN should be explained. 
7) Discussion - the word mesentery should be changed into mesorectum in the
sentence "Smooth and intact mesentery"
8) Introduction - the authors cite NCCN guidelines but they did not comment
total neoadjuvant treatment (TNT) that is included in the current NCC guidelines
and more and more commonly adopted clinical practice. At least a couple os
sentences on this issue should be added to discussion with speculation whether
only adjuvant chemotherapy may be better that TNT?
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare no competing interests.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Determining the survival benefit of postoperative radiotherapy in patients
with pT1-3N1M0 rectal cancer undergoing total mesorectal excision: a
retrospective analysis
Version: 
0 
Date: 
30 Jul 2022
Reviewer's report:
The authors of the study revealed that for rectal cancer pT1-3N1M0 operated on
without neodjuvant treatment not always postoperative radiotherapy is necessary.
They found that only in tumours larger that 50mm and when there were 3
positive lymph nodes in the specimen postoperative radiotherapy is associated
with survival benefit. The analysed data from SEER database and performed
propensity score matching to eliminate the influence of possible confounders
differently distributed in analysed groups. 
The study is interesting as after introduction of TME the rate of local recurrences
diminished significantly. Still some studies, i.e. Dutch TME trial, emphasised the
value of radiotherapy as neoadjuvant treatment. The statistical analysis is
performed and explained properly.
There are some issues that should be addressed before publication:
1) There are may censored observations in all survival curves, even when only 5
year follow-up is taken into consideration. The authors should specify what was
the actual median follow-up of the analysed patients and how many patients
were lost to follow-up. With so many censored observation the data might be not
reliable when survival is analysed. 
2) Introduction - The abbreviation should be LARC not LAGC
3) The authors stated that high quality of TME is necessary to achieve optimal
oncological results without postoperative radiotherapy. On the other hand, they
wrote in the discussion that the quality of rectal specimen was unknown in the
study. This is inconsistent. Analysed patients were operated on between 2004
and 2016 so the quality of surgery may be different during 12 years. 
4) Results section - the authors stated that all patients had underwent radical
surgery. Please specify whether only R0 patients were included or R1 as well?
5) Discussion - the authors stated that radiotherapy impaired anal function and
voiding but did not mention that this complication may be the results of surgery
and sacral nerves injury not radiotherapy only.
6) Discussion - the abbreviation LPLN should be explained. 
7) Discussion - the word mesentery should be changed into mesorectum in the
sentence "Smooth and intact mesentery"
8) Introduction - the authors cite NCCN guidelines but they did not comment
total neoadjuvant treatment (TNT) that is included in the current NCC guidelines
and more and more commonly adopted clinical practice. At least a couple os
sentences on this issue should be added to discussion with speculation whether
only adjuvant chemotherapy may be better that TNT?
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare no competing interests.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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