Methods to optimise colorectal anastomosis during laparoscopic operations for rectal cancer

Abstract

Introduction. Anastomosis failure is a serious complication in colorectal surgery. To date, there is no common standardized technique for the formation of colorectal anastomosis.Aim. To compare the effectiveness and safety “side-to-end” and “end-to-end” coloteral anastamoses.Materials and methods. A retrospective comparative analysis of the database of patients with rectal and sigmoid colon cancer who underwent surgical treatment with formation of colorectal anastomosis in the Republican Diagnostic Center of Baku from 2017 to 2022 was conducted. The statistical analysis was performed using the IBM SPSS v. 26 software. The parameters analyzed were: frequency of anastomotic failure, formation of preventive stoma depending on colorectal anastomosis type.Results. The group of patients with “side-to-end“ anastomoses included 82 patients, “end-to-end” – included 78 patients. In the “end-to-end” group as compared with “side-to-end“ group, there were significantly more patients with body mass index >of more than 30 kg/m2 (17 (28.1 %) vs 9 (11 %), p = 0.05), fewer patients with tumor localization in the middle and lower ampullary parts of the rectum (16 (20.5 %) vs 33 (40.2 %), p = 0.009). There were no other clinically significant differences in the risk of anastomotic failure between the groups. Anastomosis failure occurred more frequently in patients with “end-to-end“ anastomosis (n = 9 patients, 11.5 %) as compared to “side-to-end“ anastomosis (n = 2 patients, 2.4 %) (p = 0.023). At the same time, clinically pronounced anastomotic failure requiring surgical treatment was observed in 4 patients (5.1 %) from the “end-to-end“ group while there was 1 (1.2 %) failure in patient of the “side-to-endv group (p = 0.2). Significantly more often, a preventive stoma was formed in the “end-to-end“ group (n = 28 patients, 35.9 %) as compared with the “side-to-end“ group (n = 5 patients, 6.1 %), p <0.001. However, when conducting multivariate analysis, none of the criteria studied significantly influenced the risk of anastomotic failure.Conclusions. In our retrospective study, the incidence of anastomotic failure was lower when the “side-to-end“ technique was employed, however effect of this factor was not confirmed by multivariate analysis.