The report examines the feasibility of underground and overground Metro systems along the proposed alignment from Kazhakootam to East Fort, via Sreekaryam and Medical College Junction. Key considerations include whether the route should incorporate Medical College Junction and which sections should employ an underground system.

Biju Prabhakar, the officer overseeing the project, clarified that the report includes recommendations rather than a finalized alignment. "The finance department is reviewing the suggestions, and we expect approval soon," he stated.

KMRL Managing Director Loknath Behera confirmed that the agency is awaiting the government's decision to proceed. Once approved, the Delhi Metro Rail Corporation (DMRC) will update the detailed project report (DPR), paving the way for a cabinet decision. "We aim to complete this process within the current financial year," he added.

In July 2024, the government tasked KMRL with conducting a feasibility study for an alternative alignment to enhance ridership, as the previously proposed alignment by DMRC was deemed impractical. The revised study recommends starting the Metro line at Kazhakootam instead of Pallipuram due to the narrow NH 66 median, which makes constructing Metro pillars along that stretch infeasible.

Additionally, the revised alignment proposes rerouting the Metro to pass through the Medical College Hospital via Kariavattom, avoiding the original path through Kesavadasapuram. Heritage conservation concerns also influenced the recommendations, as elevated Metro lines were deemed unsuitable for key city areas such as Statue and Palayam. The government also suggested constructing the Metro yard at the Kariavattom University campus for better logistical efficiency.

KMRL submitted an executive summary of the DPR in February 2024. The earlier DPR offered two alignment options: one via Kariavattom, MG Road, Thampanoor, and Killipalam, and another along NH 66, passing through Kazhakootam, Akkulam, Enchakkal, and Killipalam. Although the full DPR was initially expected in January 2024, its submission faced delays due to factors including the model code of conduct.