Abstract
Purpose
Surgical technique and perioperative management in rectal cancer surgery have been substantially improved and standardized during the last decades. However, anastomotic leakage following low anterior resection still is a significant problem. Based on animal experimental data of improved healing of compression anastomosis, we hypothesized that a compression anastomotic device might improve healing rates of the highest-risk anastomoses.
Methods
All low anterior resections for rectal cancer performed or directly supervised by the senior author between January 2004 and June 2012 were analyzed. Only patients with a stapled or compression anastomosis located within 6 cm from the anal verge were included. Until December 2008, circular staplers were employed, while since January 2009, a novel compression anastomotic device was used for rectal reconstruction exclusively.
Results
Out of 197 patients operated for rectal cancer, a total of 96 (34 females, 35.4 %) fulfilled inclusion criteria. Fifty-eight (60.4 %) were reconstructed with circular staplers and 38 (39.6 %) using a compression anastomotic device. Significantly, more laparoscopic procedures were recorded in the compression anastomosis group, but distribution of gender, age, body mass index, American Society of Anaesthesiologists score, rate of preoperative radiotherapy, tumor staging, or stoma diversion rate were similar. Anastomotic leakage was observed in seven cases (7/58, 12.1 %) in the stapled and twice (2/38, 5.3 %) in the compression anastomosis group (p = 0.26).
Conclusions
In this series, rectal reconstruction following low anterior resection using a novel compression anastomotic device was safe and (at least) equally effective compared to traditional circular staplers concerning leak rate.
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References
Knight CD, Griffen FD (1980) An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 88:710–714
Dahlberg M, Glimelius B, Pahlman L (1999) Changing strategy for rectal cancer is associated with improved outcome. Br J Surg 86:379–384
Martling A, Holm T, Johansson H, Rutqvist LE, Cedermark B (2001) The Stockholm II trial on preoperative radiotherapy in rectal carcinoma: long-term follow-up of a population-based study. Cancer 92:896–902
Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482
Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 69:613–616
Karanjia ND, Corder AP, Bearn P, Heald RJ (1994) Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 81:1224–1226
Matthiessen P, Hallböök O, Andersson M, Rutegard J, Sjödahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6:462–469
Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358
Jestin P, Pahlman L, Gunnarsson U (2008) Risk factors for anastomotic leakage after rectal cancer surgery: a case–control study. Colorectal Dis 10:715–721
Kaidar-Person O, Rosenthal RJ, Wexner SD, Szomstein S, Person B (2008) Compression anastomosis: history and clinical considerations. Am J Surg 195:818–826
Ho YH, Ashour MA (2010) Techniques for colorectal anastomosis. World J Gastroenterol 16:1610–1621
Zbar AP, Nir Y, Weizman A, Rabau M, Senagore A (2012) Compression anastomoses in colorectal surgery: a review. Tech Coloproct 16:187–199
Dauser B, Herbst F (2009) NITI endoluminal compression anastomosis ring (NITI CAR27): a breakthrough in compression anastomoses? Eur Surg 41:116–119
Kopelman D, Lelcuk S, Sayfan J et al (2007) End-to-end compression anastomosis of the rectum: a pig model. World J Surg 31:532–537
Stewart D, Hunt S, Pierce R et al (2007) Validation of the NITI Endoluminal Compression Anastomosis Ring (EndoCAR) device and comparison to the traditional circular stapled colorectal anastomosis in a porcine model. Surg Innov 14:252–260
Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147:339–351
Lustosa SA, Matos D, Atallah AN, Castro AA (2001) Stapled versus hand-sewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev CD003144
Carlsen E, Schlichting E, Guldvog I, Johnson E, Heald RJ (1998) Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 85:526–529
Pahlman L, Bohe M, Cedermark B et al (2007) The Swedish rectal cancer registry. Br J Surg 94:1285–1292
Hardy KJ (1990) Non-suture anastomosis: the historical development. Aus N Z J Surg 60:625–633
Wullstein C, Gross E (2000) Compression anastomosis (AKA-2) in colorectal surgery: results in 442 consecutive patients. Br J Surg 87:1071–1075
Chen TC, Yang MJ, Chang CP (1995) New anastomotic gun for biofragmentable anastomotic ring in low anterior resection. Dis Colon Rectum 38:1214–1216
D’Hoore A, Hompes D, Folkesson J, Penninckx F, Pahlman L (2008) Circular “superelastic” compression anastomosis: from the animal lab to clinical practice. Minim Invasive Ther Allied Technol 17:172–175
Tulchinsky H, Kashtan H, Rabau M, Wasserberg N (2010) Evaluation of the NiTi Shape Memory BioDynamix ColonRing™ in colorectal anastomosis: first in human multi-center study. Int J Colorect Dis 25:1453–1458
Dauser B, Winkler T, Loncsar G, Herbst F (2011) Compression anastomosis revisited: prospective audit of short- and medium-term outcomes in 62 rectal anastomoses. World J Surg 35:1925–1932
Buchberg BS, Masoomi H, Bergman H, Mills SD, Stamos MJ (2011) The use of compression device as an alternative to hand-sewn and stapled colorectal anastomoses: is three a crowd? J Gastrointest Surg 15:304–310
Lee JY, Woo JH, Choi HJ et al (2011) Early experience of the compression anastomosis ring (CAR™ 27) in left-sided colon resection. World J Gastroenterol 17:4787–4792
Kang J, Park MG, Hur H, Min BS, Lee KY, Kim NK (2012) Safety and efficacy of the NiTi shape memory compression anastomosis ring (CAR/ColonRing) for end-to-end compression anastomosis in anterior resection or low anterior resection. Surg Innov 20:164–170
Avgoustou C, Penlidis P, Tsakpini A, Sioros C, Giannousis D (2012) Compression anastomoses in colon and rectal surgery with the NiTi ColonRing™. Tech Coloproct 16:29–35
Koo EJ, Choi HJ, Woo JH et al (2012) Anastomosis by use of compression anastomosis ring (CAR™ 27) in laparoscopic surgery for left-sided colonic tumor. Int J Colorect Dis 27:391–396
D’Hoore A, Cohen C, Albert M, et al. (2012) COMPRES final results: nitinol compression anastomosis results in a much lower than expected rate of anastomotic leak in low anterior resection (LAR). Poster presented at the ASCRS Meeting; June 2–6, 2012; San Antonio, TX
Masoomi H, Luo R, Mills S, Carmichale J, Senagore A, Stamos M (2013) Compression anastomosis ring device in colorectal anastomosis: a review of 1,180 patients. Am J Surg 205:447–451
Kang CY, Halabi WJ, Chaudhry OO et al (2013) Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA 148:65–71
Matthiessen P, Hallböök O, Rutegard J, Simert G, Sjödahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214
Floodeen H, Hallböök O, Rutegard J, Sjödahl R, Matthiessen P (2012) Early and late symptomatic anastomotic leakage following low anterior resection of the rectum for cancer: are they different entities? Colorectal Dis 15:334–340
Schmidt O, Merkel S, Hohenberger W (2003) Anastomotic leakage after low rectal stapler anastomosis: significance of intraoperative anastomotic testing. Eur J Surg Oncol 29:239–243
Breukink S, Pierie J, Wiggers T (2006) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev CD005200
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Dauser, B., Braunschmid, T., Ghaffari, S. et al. Anastomotic leakage after low anterior resection for rectal cancer: comparison of stapled versus compression anastomosis. Langenbecks Arch Surg 398, 957–964 (2013). https://doi.org/10.1007/s00423-013-1103-4
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DOI: https://doi.org/10.1007/s00423-013-1103-4