Regarding "Stoma site extraction does not increase complication rates in robot-assisted colorectal surgery": a call for nuance in patient selection, long-term scrutiny, and methodological rigor.

This correspondence responds to the study by Stahl et al. on stoma site extraction (SSE) in robot-assisted colorectal surgery. While we commend the authors for addressing this important technical question, we raise critical concerns regarding the study's methodological limitations. We argue that significant selection bias, particularly confounding by indication, may have led to an underestimation of complication risks in the SSE group. Furthermore, the 1-year follow-up period is insufficient to adequately assess the incidence of late complications such as parastomal hernia, a limitation exacerbated by the reliance on symptom-driven imaging for diagnosis. The reported reduction in operative time may also be confounded by surgeon-specific factors. We conclude that while SSE is a promising technique, its long-term safety and efficiency remain unproven. We advocate for future multi-center, prospective registries with mandated long-term follow-up, standardized imaging protocols, and inclusion of patient-reported outcomes to provide definitive evidence to guide clinical practice.