Standard versus eversion-modified double-staple technique for low colorectal anastomoses after resection of rectal cance
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ORIGINAL ARTICLE
Standard versus eversion‑modified double‑staple technique for low colorectal anastomoses after resection of rectal cancer Giulio Illuminati1 · Rocco Pasqua1 · Bruno Perotti1 · Paolo Urciuoli1 · Priscilla Nardi1 · Chiara Fratini1 · Fabio Carboni2 · Mario Valle2 Received: 2 July 2020 / Accepted: 6 September 2020 © The Author(s) 2020
Abstract Purpose The double-staple technique, performed as either the standard procedure or after eversion of the rectal stump, is a well-established method of performing low colorectal anastomoses following the resection of rectal cancer. Eversion of the tumor-bearing ano-rectal stump was proposed to allow the linear stapler to be fired at a safe distance of clearance from the tumor. We conducted this study to compare the results of the standard versus the eversion-modified double-staple technique. Methods The subjects of this retrospective study were 753 consecutive patients who underwent low stapled colorectal anastomosis after resection of rectal cancer. The patients were divided into two groups according to the method of anastomosis used: Group A comprised 165 patients (22%) treated with the modified eversion technique and group B comprised 588 patients (78%) treated with the standard technique. The primary endpoints of the study were postoperative mortality, surgery-related morbidity, the number of sampled lymph nodes in the mesorectum, and late disease-related survival. Results Postoperative mortality was 1.2% in group A and 1.7% in group B (p = 0.66). Postoperative morbidity was 12% in group A and 11% in group B (p = 0.75). The mean number of sampled lymph nodes in the mesorectum was 23 (range 17–27) in group A and 24 (range 19–29) in group B (p = 0.06). The 5-year disease-related survival was 73% in group A and 74% in group B (p = 0.75). Conclusion The standard and eversion-modified double-staple techniques yield comparable results. Keywords Colorectal cancer · Double-stapled colorectal anastomosis · Stapling technique
Introduction Anterior resection of the rectum with complete excision of the mesorectum, performed either as an open surgery or laparoscopically, remains the standard treatment for rectal cancer [1–4]. The double-staple technique [5] is widely accepted and has simplified low colorectal and coloanal anastomoses after anterior resection for cancer. Applying the linear stapler to close the anorectal stump within the abdomen can be difficult or unsafe to ensure a correct clearance distance from the tumor; therefore, everting the * Giulio Illuminati [email protected] 1
The Department of Surgical Sciences, University of Rome “La Sapienza”, Policlinico Umberto Primo, Viale del Policlinico, 00166 Rome, Italy
The Department of Surgical Oncology, Regina Elena Cancer Institute, Rome, Italy
2
anorectal stump bearing the tumor, with extra-anal closure of the stump itself and resection of the tumor, followed by gentle re-positioning of the stump back into the perineum and anastomosis with a circular stapler is a feasible alternative
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