Abstract
Purpose
The aim of this study was to describe the different techniques currently used in Denmark to construct right-sided ileocolic anastomoses in minimally invasive surgery, and investigate, compare and analyse the anastomotic configurations and their anastomotic leakage (AL) rates.
Methods
This was a retrospective register-based, study design using prospectively collected data from the Danish Colorectal Cancer Group (DCCG) database. All patients aged 18 years or older with a malignant colorectal tumour in Denmark in the period of 1 February 2015 until 31 December 2019, and who had an elective, curative, minimally invasive right hemicolectomy (MIRH) with ileocolic anastomosis, were included.
Results
Three thousand three hundred ninety-eight patients were included. The most commonly used anastomotic approach was the extracorporeal (EC) hand-sewn anastomosis (HA) with end-to-end configuration (59%) and the second most used was the EC stapled anastomosis (SA) side-to-side configuration (20%). The latter had a higher AL rate compared with the hand-sewn technique (3.8% vs. 1.3%), and had significantly higher odds ratio (OR) (OR: 2.85, 95% CI: 1.56–4.92, p < 0.0001) for AL in the adjusted regression model. The least used technique was the end-to-side HA which also had a significantly higher OR (OR: 3.05, 95% CI: 1.30–7.15, p = 0.010) compared with the end-to-end HA. Smoking was an independent factor associated with higher OR for AL.
Conclusion
The ileocolic end-to-end HA was the most commonly used technique and had the lowest AL rate in MIRH for colon cancer. The EC SA technique and tobacco smoking were independent risk factors for leakage of the ileocolic anastomosis.
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Acknowledgements
We are grateful to the Danish Colorectal Cancer Group (DCCG) and the Danish Clinical Quality Program–National Clinical Registries (RKKP) for supplying us with national register data.
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There were no ethical considerations in this register study. The study was approved by the Danish Data Protection Agency in Regional committee with journal number 19/26020.
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What does this paper add to the literature?
This paper reports in detail the types of ileocolic anastomoses used in Denmark over the years 2015–2019 in an attempt to elucidate any association between the construction technique and subsequent anastomotic leakage.
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Würtz, H., Bundgaard, L., Rahr, H.B. et al. Anastomosis technique and leakage rates in minimally invasive surgery for right-sided colon cancer. A retrospective national cohort study. Int J Colorectal Dis 37, 701–708 (2022). https://doi.org/10.1007/s00384-022-04107-9
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DOI: https://doi.org/10.1007/s00384-022-04107-9