PONE-D-20-17999

Insights from a global snapshot of the change in elective colorectal practice due to the COVID-19 pandemic

PLOS ONE

Dear Dr. Mason,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Zhi Ven Fong, M.D., M.P.H.

Academic Editor

PLOS ONE

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Reviewers' comments:

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is a well-written paper that uses survey data from colorectal surgeons around the globe to highlight the important impact that COVID-19 has had on care of colorectal cancer patients. While many of the conclusions are expected, they do well to summarize important alterations in practice using their survey data

Intro, pg 2 line 96: Would remove “prospectively” and just say “collected survey data”. Prospectively implies that one would follow a cohort or outcome measure over time after the initial survey

Methods: Were surgeons specifically sent invitations or were surgeons directed to a study info page/registration page on the society websites/social media pages, or were invites sent to all members of the societies? If exact number of invites is known, it should be presented. In regard to the critical care bed stress and hospital bed stress, you define high load as a strata of COVID-19 exceeding capacity, however one could argue that a hospital with high hospital bed and critical bed size with high covid-10 load is under significant stress – however by your definition, it would be considered medium stress. It is impossible for hospitals with high bed/ICU capacity to be in the high bed stress loads based on this definition, correct? Perhaps representing bed stress on % of beds filled with COVID-19 patients? Table 1 should also include breakdown of hospitals by number of hospital beds and ICU beds.

Results: There are 191 respondents from 159 centers. This implies that some centers have more than one surgeon replying. Are these double counted in the results?

Otherwise the results are well presented

Reviewer #2: This is an interesting article that aims to explore the impact of the COVID 19 pandemic on the diagnosis and treatment of colorectal cancer. The authors conducted a global survey to assess the response of colorectal and general surgeons around the world.

Major concern: There is significant bias since the study has included a large number of countries with striking differences in healthcare systems, systematic response to the pandemic, a wide variation in COVID incidence/mortality, etc. With this degree of bias it is really difficult to make comparisons and come up with sound conclusions.

There are some interesting questions asked in the survey, but we do not get the full picture based on the answers provided. For instance, does the dramatic decrease in use of laparoscopy mean that there was an equivalent increase in open surgery or that the operations were postponed to a later date?

Would like to see additional tables from some of the analyses that the authors describe in the last 2 paragraphs of the results.

What are the future steps that the authors suggest based on the results of the study?

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Reviewer #1: No

Reviewer #2: No

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Insights from a global snapshot of the change in elective colorectal practice due to the COVID-19 pandemic

PONE-D-20-17999R1

Dear Dr. Mason,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Zhi Ven Fong, M.D., M.P.H.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have satisfactorily responded to this reviewers comments. I agree with reviewer 2 that a paragraph with implications for care and research moving forward is a necessary addition.

Reviewer #2: The authors have addressed all my comments. I commend them for their efforts. I would like to see another survey in the future with additional questions that will help us improve patient care during a potential second wave of the pandemic.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No