End-to-end versus end-to-side stapled anastomoses after anterior resection for rectal cancer.
OBJECTIVE
Sphincter-saving procedures for resection of mid and, in some cases, of distal rectal tumors have become prevalent as their safety have been established. Increased anastomotic leak rate, associated with the type of anastomosis and the distance from the anal verge, has been reported. To compare surgical outcomes of end-to-end and end-to-side anastomosis after anterior resection for T1-T2 rectal cancer.


METHODS
During the study period, a total of 298 rectal cancer patients were treated. Patients with T1-T2 rectal cancer (i.e., tumor level < or =15 cm from the anal verge) fit for surgery were asked to participate in the study. Patients were randomized to receive either an end-to-end anastomosis or an end-to-side anastomosis using the left colon. Surgical results and complications were recorded.


RESULTS
Seventy-seven patients were randomized. Thirty-seven end-to-end anastomoses and 40 end-to-side anastomoses were performed. Anastomotic leakage after end-to-end anastomosis was 29.2%, while after end-to-side anastomosis was 5% (P = 0.005). In the end-to-end group 11 patients had anastomotic leaks: nine patients needed a re-intervention with colostomy creation subsequently closed in seven cases. Two patients of the end-to-side group experienced anastomotic leakage and were successfully treated conservatively.


CONCLUSIONS
Regarding postoperative surgical complications, end-to-side anastomosis is a safe procedure.
Brisinda
Giuseppe
G
Department of Surgery, Catholic University Hospital Agostino Gemelli, Rome, Italy. gbrisin@tin.it
Vanella
Serafino
S
Cadeddu
Federica
F
Civello
Ignazio Massimo
IM
Brandara
Francesco
F
Nigro
Casimiro
C
Mazzeo
Pasquale
P
Marniga
Gaia
G
Maria
Giorgio
G
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D003082:Colectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*