Title: Safety and feasibility of minimally invasive gastrectomy following preoperative
chemotherapy for highly advanced gastric cancer
Version: 2 Date: 08 Nov 2023
Reviewer:  Chikara Kunisaki
Reviewer's report:
Major comments
This topic is important. However, there are some points to be addressed more clearly and to
be corrected.
Previously some studies reported similar outcomes. What are the most noteworthy points in this
study as compared to the previous studies?
Minor comments
1. Please clarify the definition of highly advanced gastric cancer. What is the difference between
highly advanced gastric cancer and advanced gastric cancer?
2. Please discuss the rationale to analyze the outcome in patients with cStage III and cStage IV
together.
3. In this study, an advanced large tumor is defined as one >cT3 and >5 cm. Usually, a large
tumor is defined as one >8 cm. Please discuss the rationale of the definition in this study.
4. This is a retrospective study. How did authors obtain the IC for this study? Opt-out?
Please clarify this issue.
5. Multivariate analysis was performed using variables with a P-value <0.10 in the univariate
analysis.
Is this method statistically correct? Please consult the statistician.
6. Table 1, 2, and 5, we need more sophisticated tables.
7. Please show the precise information of adjuvant chemotherapy.
8. In Table 3. Please add the unit to BMI.
9. In this study, authors argued the superiority of RG for splenectomy. It may be true as the multi-
articulated joint angle of RG is a great surgical advantage. However, RG was introduced after the
sufficient experience of LG. therefore, the surgical learning curve must affect the outcomes. It is
necessary to discuss this important issue. Moreover, the experience of the surgeons participated
in this study is also important. Although authors argued the surgeon’s qualification, it is better
to offer the information of the experiences of the surgeons in each group.
10. Authors raised four findings. Of these, authors pointed out the safety and feasibility of
minimally invasive surgery as first point, and also pointed out those regardless of the surgical
method as third point. These can be integrated into one. Please reconsider this issue.
11. In combination with more effective regimens of preoperative chemotherapy, minimally
invasive surgery may play an important role in multidisciplinary treatment in the future.
Minimally invasive surgery can be changed to RG? Please reconsider this issue.
12. Ethics approval and informed consent to participate
---- and written informed consent was obtained from all individual participants included in this
study.
Is it true? I wonder some participants died of gastric cancer or other diseases. Is it possible to
obtain the written informed consent from all patients? Please clarify this issue.
Title: Safety and feasibility of minimally invasive gastrectomy following preoperative
chemotherapy for highly advanced gastric cancer
Version: 2 Date: 08 Nov 2023
Reviewer:  Chikara Kunisaki
Reviewer's report:
Major comments
This topic is important. However, there are some points to be addressed more clearly and to
be corrected.
Previously some studies reported similar outcomes. What are the most noteworthy points in this
study as compared to the previous studies?
Minor comments
1. Please clarify the definition of highly advanced gastric cancer. What is the difference between
highly advanced gastric cancer and advanced gastric cancer?
2. Please discuss the rationale to analyze the outcome in patients with cStage III and cStage IV
together.
3. In this study, an advanced large tumor is defined as one >cT3 and >5 cm. Usually, a large
tumor is defined as one >8 cm. Please discuss the rationale of the definition in this study.
4. This is a retrospective study. How did authors obtain the IC for this study? Opt-out?
Please clarify this issue.
5. Multivariate analysis was performed using variables with a P-value <0.10 in the univariate
analysis.
Is this method statistically correct? Please consult the statistician.
6. Table 1, 2, and 5, we need more sophisticated tables.
7. Please show the precise information of adjuvant chemotherapy.
8. In Table 3. Please add the unit to BMI.
9. In this study, authors argued the superiority of RG for splenectomy. It may be true as the multi-
articulated joint angle of RG is a great surgical advantage. However, RG was introduced after the
sufficient experience of LG. therefore, the surgical learning curve must affect the outcomes. It is
necessary to discuss this important issue. Moreover, the experience of the surgeons participated
in this study is also important. Although authors argued the surgeon’s qualification, it is better
to offer the information of the experiences of the surgeons in each group.
10. Authors raised four findings. Of these, authors pointed out the safety and feasibility of
minimally invasive surgery as first point, and also pointed out those regardless of the surgical
method as third point. These can be integrated into one. Please reconsider this issue.
11. In combination with more effective regimens of preoperative chemotherapy, minimally
invasive surgery may play an important role in multidisciplinary treatment in the future.
Minimally invasive surgery can be changed to RG? Please reconsider this issue.
12. Ethics approval and informed consent to participate
---- and written informed consent was obtained from all individual participants included in this
study.
Is it true? I wonder some participants died of gastric cancer or other diseases. Is it possible to
obtain the written informed consent from all patients? Please clarify this issue.
Please review this paper.
user
Title: Safety and feasibility of minimally invasive gastrectomy following preoperative
chemotherapy for highly advanced gastric cancer
Version: 2 Date: 08 Nov 2023
Reviewer:  Chikara Kunisaki
Reviewer's report:
Major comments
This topic is important. However, there are some points to be addressed more clearly and to
be corrected.
Previously some studies reported similar outcomes. What are the most noteworthy points in this
study as compared to the previous studies?
Minor comments
1. Please clarify the definition of highly advanced gastric cancer. What is the difference between
highly advanced gastric cancer and advanced gastric cancer?
2. Please discuss the rationale to analyze the outcome in patients with cStage III and cStage IV
together.
3. In this study, an advanced large tumor is defined as one >cT3 and >5 cm. Usually, a large
tumor is defined as one >8 cm. Please discuss the rationale of the definition in this study.
4. This is a retrospective study. How did authors obtain the IC for this study? Opt-out?
Please clarify this issue.
5. Multivariate analysis was performed using variables with a P-value <0.10 in the univariate
analysis.
Is this method statistically correct? Please consult the statistician.
6. Table 1, 2, and 5, we need more sophisticated tables.
7. Please show the precise information of adjuvant chemotherapy.
8. In Table 3. Please add the unit to BMI.
9. In this study, authors argued the superiority of RG for splenectomy. It may be true as the multi-
articulated joint angle of RG is a great surgical advantage. However, RG was introduced after the
sufficient experience of LG. therefore, the surgical learning curve must affect the outcomes. It is
necessary to discuss this important issue. Moreover, the experience of the surgeons participated
in this study is also important. Although authors argued the surgeon’s qualification, it is better
to offer the information of the experiences of the surgeons in each group.
10. Authors raised four findings. Of these, authors pointed out the safety and feasibility of
minimally invasive surgery as first point, and also pointed out those regardless of the surgical
method as third point. These can be integrated into one. Please reconsider this issue.
11. In combination with more effective regimens of preoperative chemotherapy, minimally
invasive surgery may play an important role in multidisciplinary treatment in the future.
Minimally invasive surgery can be changed to RG? Please reconsider this issue.
12. Ethics approval and informed consent to participate
---- and written informed consent was obtained from all individual participants included in this
study.
Is it true? I wonder some participants died of gastric cancer or other diseases. Is it possible to
obtain the written informed consent from all patients? Please clarify this issue.
assistant