Reviewer’s report
Title: 
Role Of Ovarian Metastases In Colorectal Cancer (ROMIC): a Dutch
study protocol to evaluate the effect of prophylactic salpingo-oophorectomy in
postmenopausal women
Version: 
0 
Date: 
22 Jul 2022
Reviewer's report:
In this report, the authors shared their protocol to estimate the incidence of
ovarian metastasis and primary ovarian cancer in postmenopausal patients with
CRC, and to evaluate the effect of oophorectomy in these patients. 
Since
enrollment started in 2000, is there any preliminary data/enrollment trend, need
to modify the protocol, etc. that the author could share? 
In addition, there are a few concerns regarding the method
1. The power calculation used an estimate of 2% rate of ovarian metastasis based
on a previous study. 
The 2% previously reported was over a 5-year follow-up,
and included younger and older patients. 
As reported, the incidence of OM is
higher in younger women. 
Taken together, the incidence rates of OM in the
study population of post-menopausal women aged 60 and up over 3 years might
not be quite 2% 
2. Would this protocol be able to shed insight on how the stage at diagnosis
could impact the effectiveness of PSO?
3. To truly evaluate the effectiveness of PSO on outcome, perhaps it is better to
exclude patients who have macroscopic evidence of ovarian involvement at the
time of surgery, as oophorectomy should then be considered therapeutic, and not
prophylactic 
In the conclusion, the authors indicated that this protocol would provide insight
into the long-term effect of PSO among post-menopausal women with CRC. 
Is
there any plan for additional follow-up after the initial 3 years?
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