Preliminary evaluation of two-row versus three-row circular staplers for colorectal anastomosis after rectal resection: a single-center retrospective analysis

Abstract

Abstract Purpose Circular staplers for colorectal anastomoses significantly ameliorated post-operative outcomes after rectal resection. The more recent three row technology was conceived to improve anastomotic resistance and, thus, lower the incidence of anastomotic complications. The aim of this study was to evaluate potential advantages of three row circular staplers(Three-CS) on anastomotic leakage(AL), stenosis(AS) and hemorrhage(AH) rates after rectal resection as compared to two row circular staplers(Two-CS). Methods All rectal resections for rectal cancer between 2016 and 2021 were retrospectively included. Patients were classified according to the circular stapler employed in Two-CS and Three-CS cohorts. AL, AS and AH rates were compared between the two populations. Additionally, the prognostic role of the type of circular stapler on AL onset was evaluated. Results Three-hundred and seventy-five patients underwent a rectal resection with an end-to-end anastomosis during the study period:197 constituted the Two-CS group and 178 the Three-CS cohort. AL rate was 6.7%, significantly higher in the Two-CS group(19-9.6%) as compared to the Three-CS cohort(6-3.4%)(p=0.01). No difference was noted in terms of AL severity. Although not statistically significant, a lower incidence rate of AL was evidenced even in the subset of patients with low rectal cancers(4.5%vs12.5% in the Two-row cohort;p=0.33). At the multivariate analysis, Two-CSs was a negative prognostic factor for AL onset(OR: 2.63;p=0.03). No difference was noted between the two groups in terms of AS and AH. Conclusion Three-row CSs significantly decrease the rate of AL after rectal resection. Further multicenter controlled trials are still needed to confirm the advantages of Three-row CSs on anastomotic complications.