Preliminary evaluation of two-row versus three-row circular staplers for colorectal anastomosis after rectal resection: a single-center retrospective analysis

• Published in: International journal of colorectal disease 2022-12, Vol.37 (12), p.2501-2510
• Main Authors: Quero, Giuseppe, Fiorillo, Claudio, Menghi, Roberta, Rosa, Fausto, Massimiani, Giuseppe, Schena, Carlo Alberto, De Sio, Davide, Laterza, Vito, Lucinato, Chiara, Papa, Valerio, Tondolo, Vincenzo, Alfieri, Sergio
• Format: Article
• Language: English
• Subjects: Anastomosis; Anastomosis, Surgical - adverse effects; Anastomotic leak; Anastomotic Leak - surgery; Clinical trials; Colorectal cancer; Comparative analysis; Complications and side effects; Gastroenterology; Hemorrhage; Hepatology; Humans; Internal Medicine; Medicine; Medicine & Public Health; Multivariate analysis; Proctectomy - adverse effects; Proctology; Rectal Neoplasms - complications; Rectal Neoplasms - surgery; Rectum; Rectum - surgery; Retrospective Studies; Statistical analysis; Stenosis; Surgery
• ISSN: 1432-1262; 0179-1958; 1432-1262
• DOI: 10.1007/s00384-022-04283-8

Purpose Circular staplers for colorectal anastomoses significantly ameliorated post-operative outcomes after rectal resection. The more recent three-row technology was conceived to improve anastomotic resistance and, thus, lower the incidence of anastomotic complications. The aim of this study was to evaluate potential advantages of three-row circular staplers (Three-CS) on anastomotic leakage (AL), stenosis (AS), and hemorrhage (AH) rates after rectal resection as compared to two-row circular staplers (Two-CS). Methods All rectal resections for rectal cancer between 2016 and 2021 were retrospectively included. Patients were classified according to the circular stapler employed in Two-CS and Three-CS cohorts. AL, AS, and AH rates were compared between the two populations. Additionally, the prognostic role of the type of circular stapler on AL onset was evaluated. Results Three-hundred and seventy-five patients underwent a rectal resection with an end-to-end anastomosis during the study period: 197 constituted the Two-CS group and 178 the Three-CS cohort. AL rate was 6.7%, significantly higher in the Two-CS group (19–9.6%) as compared to the Three-CS cohort (6–3.4%) ( p  = 0.01). No difference was noted in terms of AL severity. Although not statistically significant, a lower incidence rate of AL was evidenced even in the subset of patients with low rectal cancers (4.5% vs 12.5% in the two-row cohort; p  = 0.33). At the multivariate analysis, Two-CS was a negative prognostic factor for AL onset (OR: 2.63; p  = 0.03). No difference was noted between the two groups in terms of AS and AH. Conclusion Three-row CSs significantly decrease the rate of AL after rectal resection. Further multicenter controlled trials are still needed to confirm the advantages of three-row CSs on anastomotic complications.