Benefits of Outcomes of the Microscopic Examination of Anastomotic Donuts After Colorectal Resection for Oncological Purposes: A Medical Record-Based Study

Ihtisham Haq,Osama Shakeel,Aun Jamal,Shahid Khattak,Awais Amjad,Hannan Ali,Faizan Ullah,Aamir Ali Syed

doi:10.7759/cureus.7932

Ihtisham Haq, Osama Shakeel + Show 6 more

Open Access

https://doi.org/10.7759/cureus.7932

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Abstract

Objective The objective of the study is to investigate the benefits of pathological assessment of donuts removed during coloanal anastomosis after anterior resection.MethodologyDuring three years, 220 patients underwent circular stapled anastomosis. It is a retrospective study with convenient sampling. Involvement of donuts, the involvement of margins, length of donuts, and margins were primarily recorded. Ethical review approval was taken from the Institutional Review Board. Hospital electronic system was used to retrieve the data.ResultsTwo hundred and twenty patients underwent circular end to end anastomosis (CEEA) stapled gun anastomosis. All had adenocarcinoma. Most of the patients had T3 disease (n=113). Low anterior resection was the most common procedure followed by anterior resection and sigmoid colectomy, respectively. We performed all rectal cancers anastomosis with a circular stapling gun. On histological analyses among 220 patients, only two patients were found to have a positive distal donut. No proximal donuts were positive. Both patients were also found to have positive distal margins. The mean length of the proximal donut was 1.79±0.45 cm. The mean length of the distal donut was 1.68±0.48 cm. Two distal margins and none of the proximal margins were positive for cancer. The mean length of the proximal margin was 8.69±4.48 cm. The mean length of the distal margin was 4.9±5.98 cm. Both patients had already received six months of pre-operative chemoradiotherapy and were not offered any additional treatment. Both patients were kept on close surveillance.ConclusionRoutine analyses of the donuts after anterior resection has no impact on the management and outcome of the disease.

Highlights

Colorectal cancer is the third most common cancer and the fourth leading cause of death in the world, accounting for 1.4 million new cases worldwide [1]
Two distal margins and none of the proximal margins were positive for cancer
The incidence of colorectal cancer in Pakistan ranges from 4% to 6.8%, and it is on the rise [2]

Summary

Introduction

Colorectal cancer is the third most common cancer and the fourth leading cause of death in the world, accounting for 1.4 million new cases worldwide [1]. The incidence of colorectal cancer in Pakistan ranges from 4% to 6.8%, and it is on the rise [2]. The difficulty of hand-sewn end to end anastomosis has been significantly reduced with the advent of circular stapling guns, especially in the deep pelvis [3, 4]. Circular end to end anastomosis (CEEA) stapling gun was first described in 1979 [5]. The year, Griffin and Knight described a different way of rectal resections by closing the distal stump with a linear stapler and using a circular stapler for anastomosis (double stapling technique) [6]. An anvil is introduced in the proximal segment of the bowel

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