The Department of Surgical Sciences, University of Rome "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico, 00166, Rome, Italy.
The Department of Surgical Oncology, Regina Elena Cancer Institute, Rome, Italy.
Surg Today. 2021 May;51(5):785-791. doi: 10.1007/s00595-020-02174-5. Epub 2020 Oct 31.
The double-staple technique, performed as either the standard procedure or after eversion of the rectal stump, is a well-established method of performing low colorectal anastomoses following the resection of rectal cancer. Eversion of the tumor-bearing ano-rectal stump was proposed to allow the linear stapler to be fired at a safe distance of clearance from the tumor. We conducted this study to compare the results of the standard versus the eversion-modified double-staple technique.
The subjects of this retrospective study were 753 consecutive patients who underwent low stapled colorectal anastomosis after resection of rectal cancer. The patients were divided into two groups according to the method of anastomosis used: Group A comprised 165 patients (22%) treated with the modified eversion technique and group B comprised 588 patients (78%) treated with the standard technique. The primary endpoints of the study were postoperative mortality, surgery-related morbidity, the number of sampled lymph nodes in the mesorectum, and late disease-related survival.
Postoperative mortality was 1.2% in group A and 1.7% in group B (p = 0.66). Postoperative morbidity was 12% in group A and 11% in group B (p = 0.75). The mean number of sampled lymph nodes in the mesorectum was 23 (range 17-27) in group A and 24 (range 19-29) in group B (p = 0.06). The 5-year disease-related survival was 73% in group A and 74% in group B (p = 0.75).
The standard and eversion-modified double-staple techniques yield comparable results.
双钉技术，无论是作为标准程序还是在直肠残端外翻后进行，都是直肠切除术后进行低位结直肠吻合的成熟方法。提出外翻肿瘤-bearing 肛门直肠残端，是为了让线性吻合器在距离肿瘤安全的清除距离内点火。我们进行这项研究是为了比较标准技术与外翻改良双钉技术的结果。
本回顾性研究的对象是 753 例连续接受低位吻合器结直肠吻合术的直肠癌患者。根据吻合方法的不同，将患者分为两组：A 组 165 例（22%）采用改良外翻技术，B 组 588 例（78%）采用标准技术。研究的主要终点是术后死亡率、与手术相关的发病率、直肠系膜中采样的淋巴结数量以及晚期疾病相关的生存。
A 组术后死亡率为 1.2%，B 组为 1.7%（p=0.66）。A 组术后发病率为 12%，B 组为 11%（p=0.75）。A 组直肠系膜中采样的淋巴结平均数为 23 个（范围 17-27），B 组为 24 个（范围 19-29）（p=0.06）。A 组 5 年疾病相关生存率为 73%，B 组为 74%（p=0.75）。
标准技术和外翻改良双钉技术的结果相似。
