Review for 10.1186/s12876-021-02035-6 (2021)

Reviewer’s report
Title: 
The effects of preoperative intestinal dysbacteriosis on postoperative
recovery in colorectal cancer surgery: a prospective cohort study
Version: 
1 
Date: 
31 Aug 2021
Reviewer's report:
Many thanks to the authors for their responses, and extensive work on the
presentation of the study. I have some remaining queries.
Most importantly, I still think the current set up of the logistic regression
analysis makes interpretation of the results difficult. 
Methods
I'm a little confused as to how ICD10 codes were used. Was an electronic health
record used to identify potential patients for inclusion? I realise this seems a
minor point but as is this sentence is ambiguous. And for completeness the
ICD10 codes used to identify patients should be stated.
Time from diagnosis to admission was 2-3 weeks - is this a criteria (i.e. patients
were excluded if admission as >3 weeks post diagnosis) or a result? If it is a
result it should be moved to the appropriate section. 
Clinical variables: the one long run on sentence is hard to read. 
Were patients included who had concurrent or previous malignancies? 
Results
The text says co-morbidities were those "diagnosed at admission", how was this
conducted? Was a full patient history review and assessment conducted using
the study report form?
Thank you for your explanation on including early post-operative diarrhea in the
models. In the response there is the comment "most of these events occurred
before the infectious complications." I'd suggest patients where their
complication occurred before their diarrhea should not be included in this model
as they make the interpretation of the model very difficult. 
To clarify - the results in table 4 are for infectious complications or all
complications? This could be stated more clearly.
Language
There are some further minor edits required to the language/writing.
"anastomotic leakage remains one of the most feared complications" I'd argue
this is subjective and would be better presented as an objective comment,
perhaps just by combining this and the next sentence? 
In the introduction, the assumed causes for dysbiosis. It would be better to
provide reference to evidence demonstrating these are feasible links than present
only "assumed causes".
"nearly a quarter of patients upfront surgery" should this perhaps be before,
rather than upfront?
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
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from apparent manipulation?
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