LAUSR

To the Editor: We have read the interesting article by Jang et al based on a retrospective study from a single high-volume center with experienced colorectal surgeons. The study aims to evaluate the relationship between anastomotic leakage and local recurrence as well as cancer-specific survival and overall survival in patients with rectal cancer who undergo curative surgery after preoperative chemoradiotherapy. The authors concluded that anastomotic leakage was not associated with adverse oncologic outcomes in these patients. We agree with the authors’ literature review regarding the background of their study. Anastomotic leakage after a low anterior resection is associated with increased morbidity and mortality; this may increase in patients who underwent preoperative chemoradiotherapy leading to poor oncologic outcomes. However, the authors have listed 4 limitations of their study, which we consider to be a large number. Furthermore, we have noted additional limitations that could question the conclusion of their work. The first criticism is regarding patient selection for this retrospective study. A total of 1195 patients underwent surgery for locally advanced rectal cancer after preoperative chemoradiotherapy. Of these, only 698 (58.4%) patients were included in the study, which means that 497 patients did not fulfill the inclusion criteria. At this stage, readers need to know the distribution of patients within the different exclusion groups. It is difficult to believe that the number of patients with missing pathologic reports is high. If a large number of patients are excluded due to loss to follow-up, it will introduce a huge bias toward a better outcome for the remaining cohort. This is because patients who are lost to follow-up are mainly those who died, underwent reoperation elsewhere, or were unsatisfied with the management; therefore,