Qi Xinyu, Xu Kai, Liu Maoxing, Tan Fei, Gao Pin, Zhou Chuanyong, Yao Zhendan, Zhang Nan, Yang Hong, Zhang Chenghai, Xing Jiadi, Cui Ming, Su Xiangqian
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, P.R. China.
State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China.
BMC Surg. 2025 Jan 7;25(1):11. doi: 10.1186/s12893-024-02749-w.
Anastomotic leakage (AL) is a serious complication that may occur following the double stapling technique (DST). The study aims to investigate the efficacy of anastomotic reinforcement using barbed sutures in preventing AL after laparoscopic low anterior resection (LAR) for rectal cancer.
During the period from November 1, 2018 to November 1, 2023, a total of 725 consecutive patients who had underwent laparoscopic LAR for rectal cancer were enrolled in this study. The patients were divided into two groups: the continuous barbed suture reinforcement group (N = 296) and the control group (N = 429). Inter-group comparisons were used the chi-squared test, Fisher's exact test, and nonparametric tests. Independent risk or protective factors for AL were analyzed using the multivariate logistic regression.
Among the 725 patients enrolled in this study, 24 patients (3.3%) were diagnosed with AL following surgery. The incidence of AL was lower in the reinforcement group when compared with the control group (1.4% vs. 4.7%, P = 0.014). In multivariate regression analyses, the neoadjuvant therapy (OR = 11.994, P < 0.01), tumor location (OR = 5.306, P = 0.015), anastomosis bleeding (OR = 58.822, P < 0.01), and number of staple firings used (≥ 3) (OR = 24.752, P < 0.01) were independent risk factors for AL, whereas the defunctioning stoma (OR = 0.051, P < 0.01) and reinforcing sutures (OR = 0.054, P = 0.001) were independent protective factors for AL in this study. No statistically significant differences were found in 36-item short-Form (SF-36) when evaluating the quality of patient's life between the two groups.
Laparoscopic continuous barbed suture reinforcement of anastomosis could reduce the incidence of AL without affecting the quality-of-life following LAR. Further popularization of this approach in clinical is warranted.
Retrospectively registered.
吻合口漏（AL）是双吻合器技术（DST）术后可能发生的严重并发症。本研究旨在探讨使用倒刺缝线进行吻合口加固在预防直肠癌腹腔镜低位前切除术（LAR）后AL中的疗效。
在2018年11月1日至2023年11月1日期间，本研究共纳入725例连续接受直肠癌腹腔镜LAR的患者。患者分为两组：连续倒刺缝线加固组（N = 296）和对照组（N = 429）。组间比较采用卡方检验、Fisher精确检验和非参数检验。使用多因素逻辑回归分析AL的独立风险或保护因素。
在本研究纳入的725例患者中，24例（3.3%）术后被诊断为AL。与对照组相比，加固组的AL发生率较低（1.4%对4.7%，P = 0.014）。在多因素回归分析中，新辅助治疗（OR = 11.994，P < 0.01）、肿瘤位置（OR = 5.306，P = 0.015）、吻合口出血（OR = 58.822，P < 0.01）和使用的吻合钉钉合次数（≥3）（OR = 24.752，P < 0.01）是AL的独立危险因素，而旷置造口（OR = 0.051，P < 0.01）和加固缝线（OR = 0.054，P = 0.001）是本研究中AL的独立保护因素。在评估两组患者的生活质量时，36项简明健康调查量表（SF - 36）未发现统计学显著差异。
腹腔镜下使用连续倒刺缝线加固吻合口可降低LAR术后AL的发生率，且不影响生活质量。该方法值得在临床上进一步推广。
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