Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, Rozzano, Milan, Italy.
IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, Rozzano, Milan, Italy.
Surgery. 2023 Jun;173(6):1367-1373. doi: 10.1016/j.surg.2023.02.018. Epub 2023 Mar 24.
After total mesorectal excision, distal rectal transection and anastomosis are critical for short-term, oncological, and functional outcomes, including anastomotic leak. A double-pursestring, single-stapled anastomosis avoids cross-stapling, overcoming the potential drawbacks of transabdominal rectal transection and double-stapled anastomosis. This study aims to compare the anastomotic leak rate in double-stapled and single-stapled anastomoses after minimally invasive total mesorectal excision for magnetic resonance imaging-defined low rectal cancer.
Adult patients (>18 years old) undergoing minimally invasive total mesorectal excision for magnetic resonance imaging-defined low rectal cancer with a stapled low anastomosis (below 5 centimeters from the anal verge) between January 2010 and January 2022 at a single institution were allocated to 2 groups according to the anastomosis: double-stapled (abdominal stapled transection and double-stapled anastomosis) or single-stapled (transanal rectal transection and double-pursestring single-stapled anastomosis). The exclusion criteria were nonrestorative procedures or any type of manual anastomosis. The primary endpoint was the rate of 90-day clinical and radiologic anastomotic leak.
In total, 185 single-stapled and 458 double-stapled were included. Clinical and tumor characteristics were comparable between the groups. The 90-day anastomotic leak rate was significantly lower in the single-stapled group (6.48% vs 15.28%; P = .002), with similar rates of grade and timing. Thirty- and 90-day complication rates were higher in the double-stapled group (P = .0001; P = .02), with comparable Clavien-Dindo grades. At multivariable analysis, double-stapled anastomosis (P = .01), active smoking (P = .03), and the presence of comorbidities (P = .01) resulted as independent risk factors for an anastomotic leak.
Transanal transection and double-pursestring, single-stapled anastomosis were associated with a lower anastomotic leak rate after minimally invasive total mesorectal excision for magnetic resonance imaging-defined low rectal cancer.
全直肠系膜切除术后，远端直肠横断和吻合术对于短期、肿瘤学和功能结果至关重要，包括吻合口漏。双荷包、单吻合钉吻合术避免了交叉吻合钉，克服了经腹直肠横断和双吻合钉吻合术的潜在缺点。本研究旨在比较经磁共振成像定义的低位直肠癌微创全直肠系膜切除术后双吻合钉和单吻合钉吻合的吻合口漏发生率。
2010 年 1 月至 2022 年 1 月，一家机构对经磁共振成像定义的低位直肠癌（距肛缘 5 厘米以下）行微创全直肠系膜切除，行吻合钉低位吻合术（以下简称低位吻合术）的成年患者（>18 岁），根据吻合方式分为两组：双吻合钉（腹部吻合钉横断和双吻合钉吻合）或单吻合钉（经肛门直肠横断和双荷包单吻合钉吻合）。排除标准为非修复性手术或任何类型的手工吻合术。主要终点为 90 天临床和影像学吻合口漏的发生率。
共纳入 185 例单吻合钉组和 458 例双吻合钉组。两组的临床和肿瘤特征相似。单吻合钉组的 90 天吻合口漏发生率显著较低（6.48% vs 15.28%；P =.002），且吻合口漏的分级和发生时间相似。双吻合钉组的 30 天和 90 天并发症发生率较高（P =.0001；P =.02），且并发症分级相似。多变量分析显示，双吻合钉吻合术（P =.01）、主动吸烟（P =.03）和合并症存在（P =.01）是吻合口漏的独立危险因素。
经肛门直肠横断和双荷包单吻合钉吻合术与经磁共振成像定义的低位直肠癌微创全直肠系膜切除术后吻合口漏发生率较低相关。
