Preparing for and Not Waiting for Surgery
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
Thank you to the authors for a very comprehensive and logically presented review. It was a pleasure and reassuring for those who work in the area of surgical optimisation, to read the assimilation of such a large volume of heterogeneous literature. Please address comments marked up in the PDF.
Comments for author File: 
Comments.pdf
Author Response
Thank you for your informed and helpful suggestions. We have revised the manuscript accordingly. Where we have been unable to revise, within the scope and word count of this review, we have provided justification.
With best wishes from the authors.
Author Response File: Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for Authors
Dear Authors.
The paper is very interesting and pertinent for the subject matter.
I understand that it is a review of the status quo of a very important issue such as cancer surgery to raise awareness of this public health problem and to present a framework for preoperative care, risk assessment and adopt personalized pre-habilitation to reduce risks.
The paper is written in the form of a guide and is very complete and didactic.
I am unfamiliar with this type of format, but if the editor accepts it, I have nothing more to say.
Author Response
Thank you very much for your comments.
We feel that this is a timely review and hope it will be of interest to Perioperative and oncological colleagues,
With best wishes from the authors.
Reviewer 3 Report
Comments and Suggestions for Authors
Dear authors, a very important contribution, I recommend corrections and finishing touches. In your contribution, please also discuss the possibility of implementing programmes in different areas according to economic characteristics.
1. The authors are asked to address the direct link between cancer and sedentary lifestyles in the paper. They should also clarify whether metabolic diseases associated with sedentary lifestyles may be responsible for the higher incidence of cancers and what the role of diet is in these lifestyles.
2. A more precise clarification between NAT and the parameters described by the authors is necessary here; the authors need to be specific about the mechanisms triggered by NAT that affect the observed variables that the authors are trying to show.
3. In addition to the MET, the authors should describe other instruments that are used to assess fitness and thus demonstrate the inadequacy of these instruments to improve screening.
4. The authors are asked to comment on the usefulness of the screening tools in Table 1; many factors limit a cancer patient's understanding of relevance, and there is also the issue of subjectivity in self-reporting.
5. What is the role of sarcopenic obesity and prognostic factors? What is the value of BMI in these estimates?
6. Is the skeletal muscle mass index a very useful category when taking into account other factors specific to nutritional status? OR can we calculate predictive factors from skeletal muscle mass index alone? The index needs to be explained and presented in combination with other factors to be clinically useful for predicting complications, intensive treatment, and mortality.
7. Frailty and medical treatment and frailty and psychosocial impact and medical treatment: more definitions and conclusions are needed. The use of various psychopharmaceuticals is increasing and is high in the category of patients treated.
Author Response
Thank you very much for your informed and comprehensive review of our manuscript. We have amended the manuscript accordingly and where we have felt unable to, within the scope and word count of this review, we have provided justification.
Please see attached response record along with amended manuscript.
Author Response File: Author Response.pdf
Round 2
Reviewer 3 Report
Comments and Suggestions for Authors
Dear authors, the corrections and interpretations made have contributed significantly to the message of the paper and therefore to its quality. I encourage you to continue your research work in the specific areas addressed in the paper, which would be of great importance for improving treatment outcomes.
Author Response
Thank you for your time spent reviewing our paper. We appreciated your recommendations and agree that they have contributed to the quality of the manuscript. We have an active research programme in this field and wish you all the best with your work too.
