COMPARISON OF MANUALLY CONSTRUCTED AND STAPLED ANASTOMOSES IN COLORECTAL SURGERY

Objective The authors compared both the initial and the long-term outc omes of patients undergoing stapled and sutured colorectal anastomoses . Summary Background Data Sutured and stapled large bower anastomoses are perceived to be equally safe, but concern has been raised about in creased rates of tumor recurrence with the use of stapling instruments . Methods The outcome of patients with sutured and stapled colorectal anastomoses were compared in a prospective, multicenter, randomized st udy. Factors affecting long-term outcomes were assessed by both univar iate and multivariate analysis. Results Seven hundred thirty-two patie nts were recruited. There was a significant increase in radiologic lea kage in the sutured group (14.4% vs. 5.2%, p < 0.05), but there was no difference in clinical anastomotic leak rates, morbidity, or postoper ative mortality. Tumor recurrence and cancer-specific mortality were h igher in the sutured patients (7.5% and 6.7%, respectively) and in pat ients with anastomotic leaks. Conclusions This study shows that suturi ng or stapling are equally safe in large bower surgery. However, it al so shows a long-term benefit of stapling in colorectal cancer patients .