The British journal of surgery
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The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. ⋯ Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.
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The process of innovation is always valuable and can lead to great advances, both intended and unanticipated. However, the outcomes must always be carefully examined in terms of metric which considers more than could ever be tested in a RCT.