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

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@article{48e64473533f4578bee84412bcb4974b,
title = "Increased Leak Rates Following Stapled Versus Handsewn Ileocolic Anastomosis in Patients with Right-Sided Colon Cancer: A Nationwide Cohort Study",
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.",
keywords = "Adenocarcinoma/surgery, Aged, Anastomosis, Surgical/methods, Anastomotic Leak/epidemiology, Cohort Studies, Colectomy/methods, Colon/surgery, Colonic Neoplasms/surgery, Female, Humans, Ileum/surgery, Male, Mortality, Retrospective Studies, Surgical Stapling, Suture Techniques",
author = "Andreas Nordholm-Carstensen and {Schnack Rasmussen}, Morten and Peter-Martin Krarup",
year = "2019",
month = "5",
doi = "10.1097/DCR.0000000000001289",
language = "English",
volume = "62",
pages = "542--548",
journal = "Diseases of the Colon and Rectum",
issn = "0012-3706",
publisher = "Lippincott Williams & Wilkins",
number = "5",

}

RIS

TY - JOUR

T1 - Increased Leak Rates Following Stapled Versus Handsewn Ileocolic Anastomosis in Patients with Right-Sided Colon Cancer

T2 - A Nationwide Cohort Study

AU - Nordholm-Carstensen, Andreas

AU - Schnack Rasmussen, Morten

AU - Krarup, Peter-Martin

PY - 2019/5

Y1 - 2019/5

N2 - 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.

AB - 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.

KW - Adenocarcinoma/surgery

KW - Aged

KW - Anastomosis, Surgical/methods

KW - Anastomotic Leak/epidemiology

KW - Cohort Studies

KW - Colectomy/methods

KW - Colon/surgery

KW - Colonic Neoplasms/surgery

KW - Female

KW - Humans

KW - Ileum/surgery

KW - Male

KW - Mortality

KW - Retrospective Studies

KW - Surgical Stapling

KW - Suture Techniques

U2 - 10.1097/DCR.0000000000001289

DO - 10.1097/DCR.0000000000001289

M3 - Journal article

VL - 62

SP - 542

EP - 548

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

SN - 0012-3706

IS - 5

ER -

ID: 57240443