Division of Colorectal Surgery, Keck School of Medicine, Los Angeles, California, USA.
Keck School of Medicine, Los Angeles, California, USA.
Colorectal Dis. 2022 Jan;24(1):8-15. doi: 10.1111/codi.15920. Epub 2021 Oct 7.
End-to-end anastomosis staplers are frequently used in colorectal surgery, generating two anastomotic doughnuts. Whether pathological evaluation of the doughnut changes clinical practice remains unclear. We aim to identify any effects of pathological evaluation of anastomotic doughnuts after oncological colorectal surgery.
We performed a systematic literature search utilizing PubMed, Clinicaltrials.gov, Cochrane, Embase and Web of Science databases and selected studies on evaluation of the anastomotic doughnut after oncological colorectal surgery with stapled end-to-end anastomosis. Outcome measures included: involved distal margin on the oncological sample, histological involvement of the doughnut, clinical change in management from a positive doughnut and study recommendations.
Of the 5761 studies identified, eight studies encompassing 1754 patients were evaluated. Most operations were for primary colon (37.5%) or rectal adenocarcinoma (37.5%). Incidence of distal margin involvement of the oncological sample was reported in three papers, with six positive cases (1.1%). Of the 1754 doughnut pairs evaluated, five were positive for neoplasia (0.29%), three for adenomas (0.18%) and one for metaplastic polyp (0.06%), none of which changed postoperative treatment. Four studies recommended abandoning routine histopathological evaluation of anastomotic doughnuts, while the remaining four recommended evaluation only under certain criteria, including gross distal margin <2 cm (one study), gross distal margin <3 cm (one study), tumours undetected on gross examination (one study), 'histologically aggressive cancers' or grossly involved distal margin (one study).
Routine evaluation of anastomotic doughnuts should be reconsidered, as <1% are positive for neoplasia. Exceptions may include specific scenarios where histopathology is likely to be clinically useful.
端端吻合器在结直肠外科中经常被使用，产生两个吻合环。吻合环病理评估的改变是否会影响临床实践尚不清楚。本研究旨在确定在结直肠肿瘤手术后对吻合环进行病理评估的任何影响。
我们使用 PubMed、Clinicaltrials.gov、Cochrane、Embase 和 Web of Science 数据库进行了系统的文献检索，选择了使用端端吻合器进行结直肠肿瘤手术后评估吻合环的研究。观察指标包括：肿瘤标本上的远端切缘受累、吻合环的组织学受累、阳性吻合环的临床处理变化以及研究建议。
在 5761 项研究中，有 8 项研究共纳入 1754 例患者。大多数手术是为原发性结肠癌（37.5%）或直肠癌（37.5%）。有 3 篇论文报道了肿瘤标本远端切缘受累的发生率，其中 6 例阳性（1.1%）。在评估的 1754 对吻合环中，有 5 对（0.29%）存在肿瘤，3 对（0.18%）为腺瘤，1 对（0.06%）为化生性息肉，均未改变术后治疗。4 项研究建议放弃常规吻合环的组织病理学评估，而其余 4 项研究建议仅在某些标准下进行评估，包括远端切缘<2cm（1 项研究）、远端切缘<3cm（1 项研究）、肉眼检查未发现肿瘤（1 项研究）、“组织学侵袭性癌症”或肉眼受累的远端切缘（1 项研究）。
常规评估吻合环是必要的，因为<1%的吻合环存在肿瘤。在某些情况下，如组织病理学可能具有临床意义时，可考虑进行评估。
