08634476

August 30, 2025, 08:29

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Letter to the Editor Dear Editor, We read with great interest the article “Clinical observation of combined transarterial chemoembolization and targeted therapy in postoperative recurrent colorectal cancer with liver metastasis” by Liu et al., which provides valuable insights into the efficacy and safety of multimodal therapy for this challenging clinical condition. The study’s focus on survival outcomes and quality of life offers meaningful references for clinical practice, yet there are three aspects that we believe could be further refined to enhance the robustness and interpretability of the findings. First, the article lacks detailed analysis of the impact of prior treatment history on study outcomes. As shown in Table 1, 26.7% of patients received prior systemic chemotherapy, and 13.3% had prior targeted therapy. These prior treatments may influence the response to the combined TACE-targeted therapy regimen—for example, patients with prior exposure to anti-VEGF or anti-EGFR agents might develop drug resistance, thereby affecting OS, PFS, and adverse event profiles. However, the current study does not stratify outcomes by prior treatment status or adjust for this factor in multivariate analysis. Clarifying whether prior treatment history is an independent confounding variable would help readers better understand the applicability of the study’s conclusions to different patient subgroups (e.g., treatment-naive vs. pretreated patients). Second, the description of TACE procedure standardization and dose adjustments is insufficient. The study mentions that TACE was repeated every six weeks based on tumor response and patient tolerance, but it does not specify key details such as the criteria for modifying the number of TACE sessions (e.g., how “tumor response” or “tolerance” was objectively defined) or adjustments to chemotherapeutic agent doses (e.g., whether doxorubicin/cisplatin doses were reduced in patients with liver dysfunction). Additionally, 93.3% of patients received doxorubicin and 86.7% received cisplatin, suggesting potential overlapping use of these two agents, yet the study does not explain the rationale for combined vs. single-agent selection. Variability in TACE protocols could introduce bias in outcome comparisons between treatment groups; standardizing and detailing these procedures would improve the reproducibility of the study results. Third, the quality of life (QoL) assessment lacks long-term follow-up and subgroup analysis of symptom dynamics. The study evaluates QoL only at baseline and six months post-treatment, but cancer therapy-related QoL changes may be dynamic—for instance, some patients might experience delayed improvements or worsening of symptoms (e.g., fatigue, pain) after six months. Extending QoL follow-up to 12 or 24 months would provide a more comprehensive understanding of the sustained impact of treatment on patient well-being. Furthermore, while the study notes greater QoL improvements in the bevacizumab group, it does not analyze QoL differences based on clinical characteristics such as the number of liver metastases or ECOG performance status. For example, patients with multiple metastases might derive less benefit in QoL despite similar survival outcomes, which would be clinically relevant for treatment decision-making. Overall, Liu et al.’s study makes a valuable contribution to the field of postoperative recurrent colorectal cancer with liver metastasis. Addressing the above issues would further strengthen the study’s scientific rigor and clinical relevance, providing more comprehensive guidance for clinical practice. We look forward to seeing additional data or supplementary analyses to address these points. Sincerely, Xiong Yuezhihong Yichang Central People's Hospital

First, thank you very much for your professional comments on the article published in World Journal of Gastrointestinal Surgery. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Gastrointestinal Surgery at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.

08061007

August 25, 2025, 13:53

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Dear Author(s), I read with interest your clinical study on clinical results of stapled hemorrhoidopexy in the surgical treatment of grade 4 hemorrhoids. It is quite interesting that the recurrence rates of stapled hemorrhoidopexy were found to be high in your study. I think it is a very good study that contributes to the literature. Congratulations and I wish you continued successful studies. Best Regards, Dr.Adnan Özpek

Thank you very much for your comments.