Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan.
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Tech Coloproctol. 2024 Sep 23;28(1):131. doi: 10.1007/s10151-024-03006-1.
Several methods are used for reconstruction in colon cancer surgery, including hand-sewn or stapled anastomosis. However, few reports have compared short-term outcomes among reconstruction methods. This study compared short-term outcomes between delta-shaped anastomosis (Delta) and functional end-to-end anastomosis (FEEA).
We retrospectively reviewed 1314 consecutive patients who underwent colorectal surgery with FEEA or Delta reconstruction between January 2016 and December 2023. Patients were divided into two groups according to reconstruction by FEEA (F group; n = 1242) or Delta (D group; n = 72). Propensity score matching was applied to minimize the possibility of selection bias and to balance covariates that could affect postoperative complications. Short-term outcomes were compared between groups.
Postoperative complications occurred in 215 patients (17.3%) in F group and 8 patients (11.1%) in D group. Before matching, transverse colon cancer was more frequent (p = 0.002), clinical N-positive status was less frequent (44.1% versus 16.7%, p < 0.001), distant metastasis was less frequent (11.7% versus 1.4%, p = 0.003), and laparoscopic approach was more frequent (87.8% versus 100%, p < 0.001) in D group. After matching, no differences in any clinical factor were evident between groups. Blood loss was significantly lower (28 mL versus 10 mL, p = 0.002) in D group, but operation time and postoperative complication rates were similar between groups.
Delta and FEEA were both considered safe as reconstruction methods. Further studies are needed to clarify appropriate case selection for Delta and FEEA.
在结肠癌手术中，有多种方法可用于重建，包括手工缝合或吻合器吻合。然而，很少有报道比较重建方法的短期结果。本研究比较了 Delta 吻合（Delta）和功能性端端吻合（FEEA）之间的短期结果。
我们回顾性分析了 2016 年 1 月至 2023 年 12 月期间接受 FEEA 或 Delta 重建的 1314 例连续结直肠手术患者。根据 FEEA（F 组；n=1242）或 Delta（D 组；n=72）重建将患者分为两组。应用倾向评分匹配来最小化选择偏倚的可能性，并平衡可能影响术后并发症的协变量。比较两组的短期结果。
F 组 215 例（17.3%）和 D 组 8 例（11.1%）患者发生术后并发症。匹配前，D 组横结肠癌更常见（p=0.002），临床 N 阳性状态更少（44.1%比 16.7%，p<0.001），远处转移更少（11.7%比 1.4%，p=0.003），腹腔镜方法更常见（87.8%比 100%，p<0.001）。匹配后，两组间无任何临床因素差异。D 组术中出血量显著减少（28 毫升比 10 毫升，p=0.002），但手术时间和术后并发症发生率相似。
Delta 和 FEEA 均可作为安全的重建方法。需要进一步研究以阐明 Delta 和 FEEA 的适当病例选择。
