Cutting Edge: A Comprehensive Guide to Colorectal Cancer Surgery in Inflammatory Bowel Diseases

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Our fellow researchers with this paper aim to take stock of the situation on colorectal cancer that has arisen sporadically and on what can be found in patients suffering from inflammatory bowel diseases. Clear introduction in which I would introduce, for completeness, another type of rectal neoplasia that is increasingly appearing in surgery and coloproctology clinics, anorectal squamous cell carcinoma, HPV related (doi.org/10.3390/diagnostics15020198 to be read and cited in the bibliography). Also in the introduction it can be better specified that colorectal cancer in Western countries is increasing in the population and only screening programs are keeping it under control with the first endoscopic examination recommended at the age of 45. We then agree that subsequent checks must be conducted depending on the results obtained at endoscopy and/or histological examinations of the demolished tissues. Excellent pathogenesis described. The microbiota can have an influence on this, given by dysbiosis linked to a diet rich in fats. We remember that the microbiome reacts with the genetic heritage of the colon mucosa inducing the genesis of the neoplasia (doi.org/10.3390/jcm13216578 to be read and cited in the bibliography). As for the therapeutic approach, we are increasingly moving towards discussing the case in a multidisciplinary commission to decide on a neoadjuvant therapy for cases with positive lymph nodes in both the right and left colon. In the rectum up to about 10/12 cm it can be radiotherapy, which is often the definitive cure for squamous cell carcinoma, or chemo/radiotherapy for rectal adenocarcinoma. We agree that the cornerstone is surgery, the access of which can be open, laparoscopic or robotic. The latter is especially indicated in the lower rectum because the 3D vision allows the magnification of the vision with respect for certain structures such as the innervation of the bladder and the genital tract. Obviously we absolutely agree on the complete excision of the mesorectum. Even for the left and right colon, minimally invasive access is preferred for a better postoperative period and earlier discharge. The observation of TaTME for limited low neoplasms without lymph node involvement is correct. High-volume centers can offer this wide range of solutions for this pathology (doi.org/10.3390/jcm12072708 to be read and cited in the bibliography) excellent iconography, good English, good bibliography

Author Response

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Reviewer 2 Report

Comments and Suggestions for Authors

1. Please reconsider for using Fig. 2 since it is difficult for the reader to attain the clear information common cancer types by country. All FIGURE AND TABLET should be placed after paragraph of their first statement in the content. 

2. More literature review is required on topic: 2.2. Types of dysplasia, 3.1, 3.2, 3.3, with more supporting references.

3. Please include the biologics treatment review on 3.5. Chemoprevention for CAC.

4.  The authors should concentrate on "Surgical approaches for Colorectal Cancer", however, there is only two pages describing in this crucial main component.  Significant more review on "Colorectal Cancer Surgery" is required both from research article, case report and patent.

5. Please summarize as graph indicated the trend of research article and patent published during each year such as 2010 to 2025 on Colorectal Cancer Surgery and incidence of this disease too. 

6. For 4.2 to 4.6, please include creative photo or schematic diagram representing each technique for easier understanding to the readers.

7. Before Conclusion, please summarize into the point of "Comprehensive Guide" with schematic diagram presenting the relationship. 

8. Topic of "Prospective aspect" should be addressed as one of the crucial topics of your review manuscript. 

 

Author Response

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Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

Cutting Edge: A Comprehensive Guide to Colorectal Cancer Surgery in Inflammatory Bowel
Diseases

Overview

The article tries to provide a comprehensive review of CRC surgery, highlighting advancements
such as laparoscopic and robotic-assisted procedures, which have improved recovery times and
patient outcomes. Title is the only interesting aspect of the article.

Major Comments

1. I am sorry to say this, there is nothing “Cutting Edge” about the review. There are 13 authors
included, even if each author contributes to one page it should come to 13 pages of text. In
this case first page is title and abstract. References take up 4 pages. 5 figures take up roughly
3 pages. What exactly is the information provided? Novel insights? New information?
Literature discussion?

2. Most figures are common information, most for IARC or from Global Cancer Observatory.
Figures formatting? It appears no one bothered about formatting of the manuscript. Again,
I am sorry to say this, using writing tools can provide a better manuscript.

3. Abstract: Make the abstract more succinct by removing less critical details and clearly
highlighting key insights. Incorporate statistics or specific outcomes to strengthen the claims
about advanced techniques.

4. Introduction: Provide a clearer background on why colorectal cancer surgery advancements
are critical today. Identify specific challenges or gaps that this review addresses. Smoothly
connect the problem of CRC in IBD patients to the evolution of surgical techniques.

5. Epidemiology: Add more comparisons between regions with lower and higher incidences
and possible reasons behind these disparities. Include a graph or table summarizing
incidence trends over time for easier visualization. Use bullet points for key data such as
incidence rates and geographical variations. Emphasize the positive trend in declining CRC
rates alongside potential contributing factors.

6. Pathogenesis: Enhance descriptions of key molecular pathways by explaining how specific
mutations affect cancer progression. Incorporate detailed diagrams for the molecular
differences between right-sided, left-sided, and rectal cancers. Clearly define less familiar
terms like “field cancerization” or “CpG island methylator phenotype.” Consider using a
brief summary sentence for the molecular differences between types of cancers.

7. Clinical Approaches: Provide a flowchart outlining patient categorization for surveillance
intervals. Highlight how chemopreventive therapies are integrated into clinical decision-
making. Add subheadings within subsections like “Patient-Related Factors” for better
navigation. Condense lengthy descriptions about surveillance strategies by focusing on the
most critical recommendations.

8. Surgical Approaches: Offer a more structured comparison table highlighting the pros and
cons of open colectomy, laparoscopic, and robotic procedures. Briefly mention key
advantages of each surgical approach at the beginning of each subsection. Include statistics
or case study summaries to demonstrate the efficacy of these surgical methods. Ensure
references to diagrams, like surgical steps, are clearly connected to relevant text discussions.

9. Conclusion: Suggest specific areas for research, such as cost reduction strategies for robotic
surgery. Emphasize the importance of multidisciplinary collaboration for improving CRC
outcomes.

10. References should be on or after 2020.

11. English corrections. Please use professional help.

Remark
The manuscript as it is, does not offer “Cutting Edge” information or insights. Manuscript should
be drafted from start

Comments on the Quality of English Language

Requires professional help.

Author Response

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Author Response File: Author Response.docx

Reviewer 4 Report

Comments and Suggestions for Authors

1) What is the influence of colorectal Cancer surgery in Inflammatory Bowel Diseases?

2) Figure 3 needs more explanation. Cite in the caption.

3) Molecular Mechanisms can be interpreted. 

4) Improve the resolution of figure 5.

5) In a healthy colon, CRC develops through the classic adenoma-carcinoma sequence, initiated by mutations in the APC gene. Correct the sentence.

6) Clinical Approach to Preventing Colitis-Associated CRC. Correct it as clinical outcomes.

7) Chemoprevention for CAC. Mention various strategies of chemoprevention.

8) Highlight the outcomes of the study in conclusion. 

 

Comments on the Quality of English Language

The English language and Grammatical corrections are required. 

Author Response

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Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

1. There is no the trend of "colorectal cancer surgery-related research articles" in Fig. 9 and please inform in detail of "document type" and 4.5 should include trend of published research articles
2. Please merge into single paragraph of Conclusion.
3. Please inform the permission for using Fig 1-2 in your manuscript.
4. Please consider for paragraphing of each new paragraph content.
   
   
   
   

Author Response

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Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

Format and organize the draft; it is difficult to follow through. Lot of red lines and strikethroughs. It is a draft; it does not look like a manuscript submitted for review.

Comments on the Quality of English Language

Should be improved.

Author Response

Thank you for your constructive feedback. We acknowledge the formatting issues in the submitted draft and sincerely appreciate your patience in reviewing it. To address your concerns, we have carefully reformatted and reorganized the manuscript to ensure clarity and readability.