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Dis Colon Rectum. 2019 May;62(5):542-548. doi: 10.1097/DCR.0000000000001289.

Increased Leak Rates Following Stapled Versus Handsewn Ileocolic Anastomosis in Patients with Right-Sided Colon Cancer: A Nationwide Cohort Study.

Author information

1
Department of Surgery, Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark.
2
Digestive Disease Center, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark.
3
Danish Colorectal Cancer Group, Copenhagen, Denmark.

Abstract

BACKGROUND:

Data on anastomotic leak rates after stapled versus handsewn ileocolic anastomosis are conflicting. In a Cochrane review, the combined estimate favored the stapled technique, but recent cohort studies demonstrated a 2-fold increase in anastomotic leak with the stapled approach.

OBJECTIVE:

The purpose of this study was to investigate anastomotic leak rates following stapled versus handsewn ileocolic anastomosis.

DESIGN:

This was a nationwide, retrospective cohort study.

SETTING:

Data were obtained from the Danish Colorectal Cancer Group and National Patient Registry databases.

PATIENTS:

Danish patients, ≥18 years of age, undergoing right hemicolectomy for a first-time diagnosis of adenocarcinoma in the right colon with primary anastomosis between October 2014 and December 2015 were included.

MAIN OUTCOME MEASURES:

The primary outcome was anastomotic leak rate. Secondary outcomes included 30-day mortality. Covariates included demographics, comorbidity, tumor stage, and surgical variables. Multivariable logistic regression and propensity score matching were used to adjust for confounding.

RESULTS:

The 1414 patients included 391 (28%) in the stapled group and 1023 (72%) in the handsewn group. Forty-five patients (3.2%) developed anastomotic leak: 21 of 391 (5.4%) and 24 of 1023 (2.4%) in the stapled and handsewn group (p = 0.004). This difference was confirmed in multivariable analysis (adjusted OR, 2.91; 95% CI, 1.53-5.53; p < 0.001), and after propensity score matching (OR, 2.41; 95% CI, 1.24-4.67; p = 0.009). Thirty-day mortality was 15.6% (7/45) and 2.1% (29/1369) in patients with and without anastomotic leak (p < 0.001), with no difference between the stapled and handsewn approach.

LIMITATIONS:

The study's design was retrospective, with no information on allocation to the stapled or handsewn approach.

CONCLUSIONS:

The present study demonstrated a 2-fold increase in anastomotic leak after stapled versus handsewn ileocolic anastomoses. Previous opinions on the optimal anastomosis technique for colon cancer should be scrutinized given the devastating short-term outcome of anastomotic leak. See Video Abstract at http://links.lww.com/DCR/A819.

PMID:
30489322
DOI:
10.1097/DCR.0000000000001289
[Indexed for MEDLINE]

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