Review for 10.1186/s12876-025-03882-3 (2025)

Title: Oncologic outcomes of surgically treated colorectal cancer in octogenarians: A
Comparative Study Using Inverse Probability of Treatment Weighting (IPTW)
Version: 1 Date: 20 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-As a retrospective study, there is an inherent risk of selection bias, as the data was collected
from existing medical records rather than through a randomized controlled trial. Although IPTW
helps address this issue, retrospective studies can still be limited by incomplete or inaccurate
data.
-The study was conducted in a single institution (Gangneung Asan Hospital), which limits the
generalizability of the findings to other populations or healthcare systems. The outcomes may
differ in other settings or regions, especially those with varying standards of care or different
patient demographics.
-Patients with severe comorbidities or poor functional status are typically excluded from clinical
trials, and their outcomes are not fully captured in this study. While the exclusion criteria were
clearly defined, this may result in the exclusion of a significant portion of older patients who
are most at risk for poor outcomes.
-While the study provides information on the use of adjuvant therapy, it does not delve deeply
into variations in chemotherapy regimens, surgical techniques, or postoperative care. These
factors could significantly influence the outcomes but are not fully explored, which limits the
potential for tailoring treatment strategies to specific patient needs.
-While the study does a good job of controlling for confounding variables, the discussion seems
to somewhat downplay the role of age as a factor influencing treatment decisions. While IPTW
adjustment helps balance the groups, age is still a significant factor in treatment planning,
especially regarding surgical risks, frailty, and the likelihood of comorbidities. A more balanced
discussion of how age interacts with other factors could offer a more nuanced view.
-The discussion acknowledges that octogenarians received less aggressive treatment, including
chemotherapy, but does not go into enough detail about the chemotherapy regimens or the
reasons for underuse. It would be beneficial to explore whether certain types of chemotherapy are
more tolerable for elderly patients and what factors contribute to the decision not to administer
adjuvant therapy.
-While the discussion mentions the importance of nutritional status and its correlation with
postoperative recovery and chemotherapy efficacy, it lacks a deeper exploration into the
mechanisms of this relationship. A more thorough examination of how nutritional interventions
could potentially improve treatment outcomes would be valuable, especially considering the
strong relationship between malnutrition and poor prognosis.
-The discussion briefly acknowledges the limitation of including only octogenarians who
underwent surgery, but it would benefit from a deeper reflection on how the exclusion of non-
surgical patients (who may be too frail or ill to undergo surgery) could bias the results. It would
be helpful to mention how the results might differ if the study included patients who were
deemed unsuitable for surgery.