Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The authors present an interesting, well structured review which is much broader than expected from the title. While "nutritional prehabilitation" focuses on the preoperative period , the article globally addresses many perioperative aspects of nutritional care and management in gastrointestinal cancer patients. It is more rehabilitation than prehabilitation. 

-The role of  perioperative Medical Nutrition Therapy (MNT) is missing and should be discussed.

Proposal to modify the title: "Nutritional management in patients with gastrointestinal cancer"

Author Response

Please see the attachment 

 

 

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript addresses an important and timely topic, highlighting nutritional challenges and emerging strategies for patients with gastrointestinal cancers. The authors provide a comprehensive and clinically relevant overview. However, substantial revisions are required before the manuscript can be considered for publication. While the topic is of high value, the current structure and methodology do not fully meet the standards of a scoping review, and the breadth of content at times detracts from the focus on nutritional prehabilitation.

1. Methods: Although the manuscript is labeled as a scoping review, it does not describe essential methodological components such as databases searched, search terms/keywords, inclusion and exclusion criteria, study selection process, or data charting and synthesis methods. This makes it difficult to evaluate the rigor and reproducibility of the review. Please revise the Methods section to follow PRISMA-ScR guidelines and include a flow diagram.

 

2. Overall: The paper covers malnutrition, cancer-related symptoms, pharmacologic management, digital health, behavioral science, and machine learning. While informative, much of this content extends beyond the core topic. The manuscript should be reorganized to prioritize definition and components of nutritional prehabilitation, specific evidence supporting prehabilitation in GI cancers, and gaps and future directions specific to prehabilitation. General nutritional management and cachexia pharmacotherapy can be summarized more concisely or moved to supplementary material.

 

3. Results: Many studies are cited, but the current narrative does not distinguish levels of evidence, heterogeneity across study designs, effect sizes or strengths of associations, and consistency (or lack thereof) across findings. Consider adding a summary table of key prehabilitation studies (design, sample size, outcomes, major findings). This would substantially improve clarity and usefulness.

 

4. “Pharmacologic Interventions Section Is Only Loosely Connected to Prehabilitation”: The discussion of megestrol, corticosteroids, olanzapine, and ponsegromab focuses primarily on cachexia treatment and symptom management, not prehabilitation. Recommend condensing this section and explicitly linking its relevance to the prehabilitation framework (e.g., “role as adjunctive therapy to optimize nutritional status before surgery or treatment”).

 

5. “Digital Health, Behavioral Science, and Machine Learning Sections Require Streamlining”: These sections provide interesting perspectives but are lengthy and at times tangential. Suggest integrating these into a single “Future Directions” section, highlighting their potential role specifically in nutritional prehabilitation rather than general oncology care.
6. Consider adding a dedicated section summarizing which patient groups benefit most from prehabilitation, optimal timing (pre-diagnosis, pre-surgery, early therapy, etc.), recommended intervention components (nutrition counseling, supplements, physical activity, psychosocial care), or implementation challenges in real-world settings. This addition would significantly enhance the clinical utility.

Author Response

Please see the attachment 

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

This is a good review of dietary therapy in patients with gastrointestinal symptoms from gastrointestinal cancers. There is not much in the way of outcomes data, but the review puts current practice-based recommendations in one place.

Missing is the most often utilized "prehabilitation" nutritional therapies for patients pre-operatively: enteral and parenteral nutritional support. Despite limited evidence of efficacy, most surgeons still place cancer patients on tube feeding or parenteral nutrition preoperatively, using the rationale that patients with overt malnutrition do worse than those who are reasonably well-nourished. This may be covered elsewhere in this special issue, but if not, should be covered here.

There are some oddities in the set-up of the pages that ought to be corrected before the papr is officially published:

1) Margins on the left are very large which makes for clumsy headers for the text

2) In Table 2, things that don't go together are in the same row. For example, under the Esophageal and Gastric section, "Gastric outlet obstruction" is next to "Odynophagia"--these two items do not go together. It would be better to set this table up verically, with a header (e.g., "Esophageal and Gastric Tumors") followed by two bullet points (e.g., "Nutrition challenges" and "Nutrition-impact symptoms") under each tumor type with the details filled in under each of those bullet points. There is nothing to be gained by comparisons up and down the existing columns; these are basically just lists.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

well done