General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Rome.
General Surgery Unit, "C.&G. Mazzoni" Hospital, Ascoli Piceno.
Int J Surg. 2023 Aug 1;109(8):2312-2323. doi: 10.1097/JS9.0000000000000480.
Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to analyze the effect of a three-row circular stapler on anastomotic leakage and related morbidity after left-sided colorectal resections.
A circular stapled anastomosis was performed in 4255 (50.9%) out of 8359 patients enrolled in two prospective multicenter studies in Italy, and, after exclusion criteria to reduce heterogeneity, 2799 (65.8%) cases were retrospectively analyzed through a 1:1 propensity score-matching model including 20 covariates relative to patient characteristics, to surgery and to perioperative management. Two well-balanced groups of 425 patients each were obtained: group (A) - true population of interest, anastomosis performed with a three-row circular stapler; group (B) - control population, anastomosis performed with a two-row circular stapler. The target of inferences was the average treatment effect in the treated (ATT). The primary endpoints were overall and major anastomotic leakage and overall anastomotic bleeding; the secondary endpoints were overall and major morbidity and mortality rates. The results of multiple logistic regression analyses for the outcomes, including the 20 covariates selected for matching, were presented as odds ratios (OR) and 95% confidence intervals (95% CI).
Group A versus group B showed a significantly lower risk of overall anastomotic leakage (2.1 vs. 6.1%; OR 0.33; 95% CI 0.15-0.73; P =0.006), major anastomotic leakage (2.1 vs. 5.2%; OR 0.39; 95% CI 0.17-0.87; P =0.022), and major morbidity (3.5 vs. 6.6% events; OR 0.47; 95% CI 0.24-0.91; P =0.026).
The use of three-row circular staplers independently reduced the risk of anastomotic leakage and related morbidity after left-sided colorectal resection. Twenty-five patients were required to avoid one leakage.
由于大多数左半结直肠切除术后的吻合都是使用圆形吻合器完成的，因此吻合器技术的任何变化都可能影响吻合口不良事件的发生率。本研究旨在分析三排式圆形吻合器对左半结直肠切除术后吻合口漏及相关并发症的影响。
在意大利进行的两项前瞻性多中心研究中，共有 8359 例患者纳入研究，其中 4255 例（50.9%）行圆形吻合器吻合，排除异质性的排除标准后，通过 1:1 倾向评分匹配模型回顾性分析了 2799 例（65.8%）病例，该模型包含 20 个与患者特征、手术和围手术期管理相关的协变量。两组各 425 例患者的匹配效果良好：组（A）——真正的研究对象，吻合采用三排式圆形吻合器；组（B）——对照组，吻合采用两排式圆形吻合器。推断的目标是治疗组的平均治疗效果（ATT）。主要终点是总吻合口漏和主要吻合口漏，以及总吻合口出血；次要终点是总发病率和死亡率。包括 20 个匹配选择的协变量在内的结果的多变量逻辑回归分析结果表示为比值比（OR）和 95%置信区间（95%CI）。
与组 B 相比，组 A 的总吻合口漏（2.1% vs. 6.1%；OR 0.33；95%CI 0.15-0.73；P=0.006）、主要吻合口漏（2.1% vs. 5.2%；OR 0.39；95%CI 0.17-0.87；P=0.022）和主要并发症发生率（3.5% vs. 6.6%；OR 0.47；95%CI 0.24-0.91；P=0.026）的风险显著降低。
使用三排式圆形吻合器可独立降低左半结直肠切除术后吻合口漏及相关并发症的风险。需要 25 例患者来避免一次吻合口漏。
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