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Backgrounds Anastomotic leakage following colorectal cancer is associated with significant morbidity and mortality. However, whether the choice of the treatment for anastomotic leakage may affect the oncological outcomes is under debate. We evaluated the oncological outcomes after colorectal cancer surgery for anastomotic leakage between conservative and surgical treatment. Methods We retrospectively analyzed data for patients with colorectal cancer who underwent curative colectomy from April 2010 to January 2020. Results A total 1039 patients underwent surgery colorectal cancer in our hospital. After exclusion, a total of 915 patients underwent a low anastomosis with diverting stoma for colorectal cancer of which 92 (10.0%) anastomotic leakage occurred. After stage Ⅳ and emergency surgery case were excluded, a total of 75 patients were included for the analysis. The surgical treatment group was 25 cases. The conservative treatment group was 50 cases. Early anastomotic leakage was more than in surgical treatment compared to conservative treatment (84% vs 54%, P =0.008). The 5-year overall survival rates and the 5-year disease free survival did not differ significantly between the two groups. The recurrence location of liver metastasis was more than in surgical treatment compared to conservative treatment (20% vs 2 %, P=0.02). On a multivariable analysis, anastomotic leak did not impact overall survival and disease free survival. Conclusion We found that the treatment for anastomotic leakage was not depended on increased local, distance recurrence, overall survival, and disease free survival. Our findings may help surgeons determine which AL treatment is most appropriate, when the decision is unclear.

workplace assessment tools rely at some level on subjectivity. We do not believe this undermines the validity of assessment, and indeed have come to see it in some cases as a strength. The recent manuscript by ten Cate and Regehr is an excellent exposition of those ideas. 14 Fifth, Andreatta et al suggest that assessment tools should be ''standards based.'' We agree. Unfortunately we are unaware of any established standard for operative performance other than case log minima (which is recognized as a poor surrogate). That being said, many existing workplace assessment scales effectively have a criterion standard embedded in them. For example, the SIMPL Performance scale's fourth level is ''Practice Ready''. Still, we agree that more comprehensive performance-based standards are important-especially ones defined in terms of multiple assessments over time-and describe some strategies in our paper for how they might ultimately be developed. This is an active area of research within the SIMPL consortium.Finally, we would also agree with the authors that a more sophisticated sampling strategy is appropriate as skills develop. This would ideally be one in which a learning analytic model could be used to dynamically recommend an optimal sampling frequency for individual learners, based on confidence in our ability to estimate the resident's present skill trajectory and its prediction of what added experience would be required for that learner to achieve an expected performance standard before graduation. This approach would be consistent with competency-based models for training completion. We are prototyping such models currently.We again thank Andreatta et al for their interest and work in this field, as well as their thoughtful critique of our work. We look forward to working alongside them and other colleagues to provide the scientific foundation for assessment of operative skill acquisition in support of future competency, accreditation, and certification standards.