Title: Analysis of the Correlation between Defunctioning Stoma and Postoperative Low
Anterior Resection Syndrome in Rectal Cancer#A prospective cohort study
Version: 2 Date: 14 Jul 2024
Reviewer:  Marie-Louise Lydrup
Reviewer's report:
This is an interesting paper on an important issue on functional outcome after anterior resection.
I have some questions.
The aims could be more clearly defined at the end of introduction. As it is now stated the
study attempted to explore correlation between stoma related factors and LARS. Actually other
variables were also studied.
Why did the authors chose to include both minor and major LARS as outcome instead of only
major LARS? Major LARS is more important since the impact on QoL is higher. In the study
by e.g. Sandberg et al only major LARS was evaluated. There is a possibility that the outcome
could be different studying only major LARS.
The two groups defunctioned and non-defunctioned are very different concerning type of
anastomosis. Very few patients with ISR were not defunctioned. The variables chosen for
adjustment in the analysis i.e. tumour distance, type of surgery, neoadjuvant therapy and
defunctioning are interrelated. Adjusting for all variables could not be statistically correct. Are
the authors convinced that power is enough?
Concerning exclusion of patients that experienced complications requiring reoperations: how
many patients were in this group? They should be included in the flowchart.
Concerning cutoff of early stoma reversal (6 months). This could not be considered early reversal
which is normally defined as around 2-3 months.
How do the authors explain lack of influence of tumour level on LARS at 6 months? It is very
odd since tumour level influnced LARS at both 3 and 12 months.
Page 13 line 268: The conclusion made that reversal time had no influence on LARS should be
in my opinion not so firmly stated based on the above questions.
Minor comments:
Page 4 line 84: Urination urgency is not included in LARS.
Page 5 line 108: Concerning type of treatment. The types of neoadjuvant chemo are described
later. It could be better placed in this section.
Page 6 line 123: Were really LARS scores collected via telephone calls? Normally inquiries are
collected via ordinary mail.
Title: Analysis of the Correlation between Defunctioning Stoma and Postoperative Low
Anterior Resection Syndrome in Rectal Cancer#A prospective cohort study
Version: 2 Date: 14 Jul 2024
Reviewer:  Marie-Louise Lydrup
Reviewer's report:
This is an interesting paper on an important issue on functional outcome after anterior resection.
I have some questions.
The aims could be more clearly defined at the end of introduction. As it is now stated the
study attempted to explore correlation between stoma related factors and LARS. Actually other
variables were also studied.
Why did the authors chose to include both minor and major LARS as outcome instead of only
major LARS? Major LARS is more important since the impact on QoL is higher. In the study
by e.g. Sandberg et al only major LARS was evaluated. There is a possibility that the outcome
could be different studying only major LARS.
The two groups defunctioned and non-defunctioned are very different concerning type of
anastomosis. Very few patients with ISR were not defunctioned. The variables chosen for
adjustment in the analysis i.e. tumour distance, type of surgery, neoadjuvant therapy and
defunctioning are interrelated. Adjusting for all variables could not be statistically correct. Are
the authors convinced that power is enough?
Concerning exclusion of patients that experienced complications requiring reoperations: how
many patients were in this group? They should be included in the flowchart.
Concerning cutoff of early stoma reversal (6 months). This could not be considered early reversal
which is normally defined as around 2-3 months.
How do the authors explain lack of influence of tumour level on LARS at 6 months? It is very
odd since tumour level influnced LARS at both 3 and 12 months.
Page 13 line 268: The conclusion made that reversal time had no influence on LARS should be
in my opinion not so firmly stated based on the above questions.
Minor comments:
Page 4 line 84: Urination urgency is not included in LARS.
Page 5 line 108: Concerning type of treatment. The types of neoadjuvant chemo are described
later. It could be better placed in this section.
Page 6 line 123: Were really LARS scores collected via telephone calls? Normally inquiries are
collected via ordinary mail.
Please review this paper.
user
Title: Analysis of the Correlation between Defunctioning Stoma and Postoperative Low
Anterior Resection Syndrome in Rectal Cancer#A prospective cohort study
Version: 2 Date: 14 Jul 2024
Reviewer:  Marie-Louise Lydrup
Reviewer's report:
This is an interesting paper on an important issue on functional outcome after anterior resection.
I have some questions.
The aims could be more clearly defined at the end of introduction. As it is now stated the
study attempted to explore correlation between stoma related factors and LARS. Actually other
variables were also studied.
Why did the authors chose to include both minor and major LARS as outcome instead of only
major LARS? Major LARS is more important since the impact on QoL is higher. In the study
by e.g. Sandberg et al only major LARS was evaluated. There is a possibility that the outcome
could be different studying only major LARS.
The two groups defunctioned and non-defunctioned are very different concerning type of
anastomosis. Very few patients with ISR were not defunctioned. The variables chosen for
adjustment in the analysis i.e. tumour distance, type of surgery, neoadjuvant therapy and
defunctioning are interrelated. Adjusting for all variables could not be statistically correct. Are
the authors convinced that power is enough?
Concerning exclusion of patients that experienced complications requiring reoperations: how
many patients were in this group? They should be included in the flowchart.
Concerning cutoff of early stoma reversal (6 months). This could not be considered early reversal
which is normally defined as around 2-3 months.
How do the authors explain lack of influence of tumour level on LARS at 6 months? It is very
odd since tumour level influnced LARS at both 3 and 12 months.
Page 13 line 268: The conclusion made that reversal time had no influence on LARS should be
in my opinion not so firmly stated based on the above questions.
Minor comments:
Page 4 line 84: Urination urgency is not included in LARS.
Page 5 line 108: Concerning type of treatment. The types of neoadjuvant chemo are described
later. It could be better placed in this section.
Page 6 line 123: Were really LARS scores collected via telephone calls? Normally inquiries are
collected via ordinary mail.
assistant