Title: Risk factors and prognostic analysis of microscopic positive margins after radical surgery
for proximal gastric cancer
Version: 1 Date: 22 Oct 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: My overall impression of the study is very good
REQUESTED REVISIONS:
The question is interesting and the paper is good.
Main question:
Because the study is retrospective there is a real need to have before reading the results the
practice of the authors. What type of surgery did they performed for cardia lesion ? did the
use echoendocopy in some specific cases, did the surgeon performed himself the endoscopy
before surgery, did the surgeon use peroperative frozen section analysis every time, or in selected
cases ?
A flowchart process with 2 distinctions : limited surgery or total gastrectomy and second intra
thoracic anastomosis or not and the exact rate of positive margin could be of interest.
Main interest :  That had to be more developed in the discussion chapter
Positive margin :  Near all positive margins are on the esophagus ? Only one case had positive
margin on the distal gastric part.  That could be probably interesting to exclude that case and do
a very focused analysis only in esophagus proximal positive margin.
In the analysis there is 2 groups :
i) Small lesion with positive margin : should you consider extended surgery ?
Preoperative information can help ? how to use the prognosis factors proposed ?
ii) Big lesion with positive margin :
In their practice did the authors consider using a neoadjuvant treatment before surgery for a
suspected T4 or N2 lesion ? If not it is difficult to offer a practice change regarding the published
cases, but if yes that could be very interesting. Authors could propose a preoperative neoadjuvant
treatment in cases of T4 on the CF scan.
Details:
Results :
Give the number of cases that have been excluded because of data missing.
Follow-up :
What is the rate of lost to follow-up ?
Extension of the question
The question regarding the extension of gastrectomy in case of poorly cohesive gastric cancer
exist for proximal and for distal gastric cancer too. That could be interesting to use the same
parallel analysis ? as published recently in Western patients (Total Versus Subtotal Gastrectomy
for Distal Gastric Poorly Cohesive Carcinoma. Boubaddi M, Teixeira Farinha H, Lambert C,
Pereira B, Piessen G, Gualtierotti M, Voron T, Mantziari S, Pezet D, Gronnier C; French
Association of Surgery. Ann Surg Oncol. 2024 Feb;31(2):744-752.), to confirm that subtype
analysis is not always the only criteria for decision ?
ADDITIONAL REQUESTS/SUGGESTIONS:
Risk factors and prognostic analysis of microscopic positive margins after radical surgery for
proximal gastric cancer
The question is interesting.
Main question:
Because the study is retrospective there is a real need to have before reading the results the
practice of the authors. What type of surgery did they performed for cardia lesion ? did the
use echoendocopy in some specific cases, did the surgeon performed himself the endoscopy
before surgery, did the surgeon use peroperative frozen section analysis every time, or in selected
cases ?
A flowchart process with 2 distinctions : limited surgery or total gastrectomy and second intra
thoracic anastomosis or not and the exact rate of positive margin could be of interest.
Main interest :  That had to be more developed in the discussion chapter
Positive margin :  Near all positive margins are on the esophagus ? Only one case had positive
margin on the distal gastric part.  That could be probably interesting to exclude that case and do
a very focused analysis only in esophagus proximal positive margin.
In the analysis there is 2 groups :
i) Small lesion with positive margin : should you consider extended surgery ?
Preoperative information can help ? how to use the prognosis factors proposed ?
ii) Big lesion with positive margin :
In their practice did the authors consider using a neoadjuvant treatment before surgery for a
suspected T4 or N2 lesion ? If not it is difficult to offer a practice change regarding the published
cases, but if yes that could be very interesting. Authors could propose a preoperative neoadjuvant
treatment in cases of T4 on the CF scan.
Details:
Results :
Give the number of cases that have been excluded because of data missing.
Follow-up :
What is the rate of lost to follow-up ?
Extension of the question
The question regarding the extension of gastrectomy in case of poorly cohesive gastric cancer
exist for proximal and for distal gastric cancer too. That could be interesting to use the same
parallel analysis ? as published recently in Western patients (Total Versus Subtotal Gastrectomy
for Distal Gastric Poorly Cohesive Carcinoma. Boubaddi M, Teixeira Farinha H, Lambert C,
Pereira B, Piessen G, Gualtierotti M, Voron T, Mantziari S, Pezet D, Gronnier C; French
Association of Surgery. Ann Surg Oncol. 2024 Feb;31(2):744-752.), to confirm that subtype
analysis is not always the only criteria for decision ?
Title: Risk factors and prognostic analysis of microscopic positive margins after radical surgery
for proximal gastric cancer
Version: 1 Date: 22 Oct 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: My overall impression of the study is very good
REQUESTED REVISIONS:
The question is interesting and the paper is good.
Main question:
Because the study is retrospective there is a real need to have before reading the results the
practice of the authors. What type of surgery did they performed for cardia lesion ? did the
use echoendocopy in some specific cases, did the surgeon performed himself the endoscopy
before surgery, did the surgeon use peroperative frozen section analysis every time, or in selected
cases ?
A flowchart process with 2 distinctions : limited surgery or total gastrectomy and second intra
thoracic anastomosis or not and the exact rate of positive margin could be of interest.
Main interest :  That had to be more developed in the discussion chapter
Positive margin :  Near all positive margins are on the esophagus ? Only one case had positive
margin on the distal gastric part.  That could be probably interesting to exclude that case and do
a very focused analysis only in esophagus proximal positive margin.
In the analysis there is 2 groups :
i) Small lesion with positive margin : should you consider extended surgery ?
Preoperative information can help ? how to use the prognosis factors proposed ?
ii) Big lesion with positive margin :
In their practice did the authors consider using a neoadjuvant treatment before surgery for a
suspected T4 or N2 lesion ? If not it is difficult to offer a practice change regarding the published
cases, but if yes that could be very interesting. Authors could propose a preoperative neoadjuvant
treatment in cases of T4 on the CF scan.
Details:
Results :
Give the number of cases that have been excluded because of data missing.
Follow-up :
What is the rate of lost to follow-up ?
Extension of the question
The question regarding the extension of gastrectomy in case of poorly cohesive gastric cancer
exist for proximal and for distal gastric cancer too. That could be interesting to use the same
parallel analysis ? as published recently in Western patients (Total Versus Subtotal Gastrectomy
for Distal Gastric Poorly Cohesive Carcinoma. Boubaddi M, Teixeira Farinha H, Lambert C,
Pereira B, Piessen G, Gualtierotti M, Voron T, Mantziari S, Pezet D, Gronnier C; French
Association of Surgery. Ann Surg Oncol. 2024 Feb;31(2):744-752.), to confirm that subtype
analysis is not always the only criteria for decision ?
ADDITIONAL REQUESTS/SUGGESTIONS:
Risk factors and prognostic analysis of microscopic positive margins after radical surgery for
proximal gastric cancer
The question is interesting.
Main question:
Because the study is retrospective there is a real need to have before reading the results the
practice of the authors. What type of surgery did they performed for cardia lesion ? did the
use echoendocopy in some specific cases, did the surgeon performed himself the endoscopy
before surgery, did the surgeon use peroperative frozen section analysis every time, or in selected
cases ?
A flowchart process with 2 distinctions : limited surgery or total gastrectomy and second intra
thoracic anastomosis or not and the exact rate of positive margin could be of interest.
Main interest :  That had to be more developed in the discussion chapter
Positive margin :  Near all positive margins are on the esophagus ? Only one case had positive
margin on the distal gastric part.  That could be probably interesting to exclude that case and do
a very focused analysis only in esophagus proximal positive margin.
In the analysis there is 2 groups :
i) Small lesion with positive margin : should you consider extended surgery ?
Preoperative information can help ? how to use the prognosis factors proposed ?
ii) Big lesion with positive margin :
In their practice did the authors consider using a neoadjuvant treatment before surgery for a
suspected T4 or N2 lesion ? If not it is difficult to offer a practice change regarding the published
cases, but if yes that could be very interesting. Authors could propose a preoperative neoadjuvant
treatment in cases of T4 on the CF scan.
Details:
Results :
Give the number of cases that have been excluded because of data missing.
Follow-up :
What is the rate of lost to follow-up ?
Extension of the question
The question regarding the extension of gastrectomy in case of poorly cohesive gastric cancer
exist for proximal and for distal gastric cancer too. That could be interesting to use the same
parallel analysis ? as published recently in Western patients (Total Versus Subtotal Gastrectomy
for Distal Gastric Poorly Cohesive Carcinoma. Boubaddi M, Teixeira Farinha H, Lambert C,
Pereira B, Piessen G, Gualtierotti M, Voron T, Mantziari S, Pezet D, Gronnier C; French
Association of Surgery. Ann Surg Oncol. 2024 Feb;31(2):744-752.), to confirm that subtype
analysis is not always the only criteria for decision ?
Please review this paper.
user
Title: Risk factors and prognostic analysis of microscopic positive margins after radical surgery
for proximal gastric cancer
Version: 1 Date: 22 Oct 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: My overall impression of the study is very good
REQUESTED REVISIONS:
The question is interesting and the paper is good.
Main question:
Because the study is retrospective there is a real need to have before reading the results the
practice of the authors. What type of surgery did they performed for cardia lesion ? did the
use echoendocopy in some specific cases, did the surgeon performed himself the endoscopy
before surgery, did the surgeon use peroperative frozen section analysis every time, or in selected
cases ?
A flowchart process with 2 distinctions : limited surgery or total gastrectomy and second intra
thoracic anastomosis or not and the exact rate of positive margin could be of interest.
Main interest :  That had to be more developed in the discussion chapter
Positive margin :  Near all positive margins are on the esophagus ? Only one case had positive
margin on the distal gastric part.  That could be probably interesting to exclude that case and do
a very focused analysis only in esophagus proximal positive margin.
In the analysis there is 2 groups :
i) Small lesion with positive margin : should you consider extended surgery ?
Preoperative information can help ? how to use the prognosis factors proposed ?
ii) Big lesion with positive margin :
In their practice did the authors consider using a neoadjuvant treatment before surgery for a
suspected T4 or N2 lesion ? If not it is difficult to offer a practice change regarding the published
cases, but if yes that could be very interesting. Authors could propose a preoperative neoadjuvant
treatment in cases of T4 on the CF scan.
Details:
Results :
Give the number of cases that have been excluded because of data missing.
Follow-up :
What is the rate of lost to follow-up ?
Extension of the question
The question regarding the extension of gastrectomy in case of poorly cohesive gastric cancer
exist for proximal and for distal gastric cancer too. That could be interesting to use the same
parallel analysis ? as published recently in Western patients (Total Versus Subtotal Gastrectomy
for Distal Gastric Poorly Cohesive Carcinoma. Boubaddi M, Teixeira Farinha H, Lambert C,
Pereira B, Piessen G, Gualtierotti M, Voron T, Mantziari S, Pezet D, Gronnier C; French
Association of Surgery. Ann Surg Oncol. 2024 Feb;31(2):744-752.), to confirm that subtype
analysis is not always the only criteria for decision ?
ADDITIONAL REQUESTS/SUGGESTIONS:
Risk factors and prognostic analysis of microscopic positive margins after radical surgery for
proximal gastric cancer
The question is interesting.
Main question:
Because the study is retrospective there is a real need to have before reading the results the
practice of the authors. What type of surgery did they performed for cardia lesion ? did the
use echoendocopy in some specific cases, did the surgeon performed himself the endoscopy
before surgery, did the surgeon use peroperative frozen section analysis every time, or in selected
cases ?
A flowchart process with 2 distinctions : limited surgery or total gastrectomy and second intra
thoracic anastomosis or not and the exact rate of positive margin could be of interest.
Main interest :  That had to be more developed in the discussion chapter
Positive margin :  Near all positive margins are on the esophagus ? Only one case had positive
margin on the distal gastric part.  That could be probably interesting to exclude that case and do
a very focused analysis only in esophagus proximal positive margin.
In the analysis there is 2 groups :
i) Small lesion with positive margin : should you consider extended surgery ?
Preoperative information can help ? how to use the prognosis factors proposed ?
ii) Big lesion with positive margin :
In their practice did the authors consider using a neoadjuvant treatment before surgery for a
suspected T4 or N2 lesion ? If not it is difficult to offer a practice change regarding the published
cases, but if yes that could be very interesting. Authors could propose a preoperative neoadjuvant
treatment in cases of T4 on the CF scan.
Details:
Results :
Give the number of cases that have been excluded because of data missing.
Follow-up :
What is the rate of lost to follow-up ?
Extension of the question
The question regarding the extension of gastrectomy in case of poorly cohesive gastric cancer
exist for proximal and for distal gastric cancer too. That could be interesting to use the same
parallel analysis ? as published recently in Western patients (Total Versus Subtotal Gastrectomy
for Distal Gastric Poorly Cohesive Carcinoma. Boubaddi M, Teixeira Farinha H, Lambert C,
Pereira B, Piessen G, Gualtierotti M, Voron T, Mantziari S, Pezet D, Gronnier C; French
Association of Surgery. Ann Surg Oncol. 2024 Feb;31(2):744-752.), to confirm that subtype
analysis is not always the only criteria for decision ?
assistant