Abstract
PurposeThe double-staple technique, performed as either the standard procedure or after eversion of the rectal stump, is a well-established method of performing low colorectal anastomoses following the resection of rectal cancer. Eversion of the tumor-bearing ano-rectal stump was proposed to allow the linear stapler to be fired at a safe distance of clearance from the tumor. We conducted this study to compare the results of the standard versus the eversion-modified double-staple technique.MethodsThe subjects of this retrospective study were 753 consecutive patients who underwent low stapled colorectal anastomosis after resection of rectal cancer. The patients were divided into two groups according to the method of anastomosis used: Group A comprised 165 patients (22%) treated with the modified eversion technique and group B comprised 588 patients (78%) treated with the standard technique. The primary endpoints of the study were postoperative mortality, surgery-related morbidity, the number of sampled lymph nodes in the mesorectum, and late disease-related survival.ResultsPostoperative mortality was 1.2% in group A and 1.7% in group B (p = 0.66). Postoperative morbidity was 12% in group A and 11% in group B (p = 0.75). The mean number of sampled lymph nodes in the mesorectum was 23 (range 17–27) in group A and 24 (range 19–29) in group B (p = 0.06). The 5-year disease-related survival was 73% in group A and 74% in group B (p = 0.75).ConclusionThe standard and eversion-modified double-staple techniques yield comparable results.
Highlights
Anterior resection of the rectum with complete excision of the mesorectum, performed either as an open surgery or laparoscopically, remains the standard treatment for rectal cancer [1,2,3,4]
The T value and stage of the disease at the time of operation were comparable in the two groups, according to the Union for International Cancer Control (UICC) classification
The results of this study show that the modified version of the double-stapling technique after eversion for stapled low colorectal or coloanal anastomosis, extra-anal resection of the tumor and stapled closure of the anorectal stump, performed with open [4, 6] or laparoscopic [1] surgery, is comparable to the standard double-stapling technique
Summary
Anterior resection of the rectum with complete excision of the mesorectum, performed either as an open surgery or laparoscopically, remains the standard treatment for rectal cancer [1,2,3,4]. The double-staple technique [5] is widely accepted and has simplified low colorectal and coloanal anastomoses after anterior resection for cancer. Applying the linear stapler to close the anorectal stump within the abdomen can be difficult or unsafe to ensure a correct clearance distance from the tumor; everting the. Surgery Today (2021) 51:785–791 two homogeneous groups of patients, excluding this technical variable, to validate the assumption that they are oncologically equivalent
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