Evolution and prospect of colorectal anastomosis

Abstract

Colorectal cancer is the third most common malignant tumor among men, and the second most common malignant tumor among women worldwide. As one of the most common malignant tumor, colorectal cancer has a great threat to the health of people. Although the development of radiotherapy and chemotherapy could improve the prognosis of colorectal cancer, surgery, the complete resection of the tumor, remains the only chance for the cure of this disease. Over the past hundred years, surgical oncology went in the direction of protecting organ function and improving quality of life. Anus-preserving surgery for low rectal cancer and laparoscopic colorectal surgery are exactly following this tendency. In colorectal surgery, surgeons need to perform intestinal anastomosis and recover the intestinal continuity after the excision of the abnormal bowel, thus a series of colorectal anastomosis techniques occur, including manual anastomosis, stapled anastomosis, compression anastomosis, and radiofrequency-induced thermo-fusion of intestinal anastomoses, which is currently being studied by many researchers at home and abroad. Manual anastomosis is divided into single- and two-layer anastomosis, continuous and interrupted sutures, and inverting and everting sutures performed in different ways. In this paper, we offer an overview of evolution, evaluate the safety and effectiveness, and compare the incidence of complications, particularly anastomotic leakage and anastomotic stenosis of different anastomotic techniques. After the objective elucidation of advantages and disadvantages, we are also looking forward to better colorectal anastomosis techniques in the future.