title: End-to-end versus end-to-side stapled anastomoses after anterior resection for rectal cancer.
abstract: 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.
authors.affiliation: Department of Surgery, Catholic University Hospital Agostino Gemelli, Rome, Italy. gbrisin@tin.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Brisinda
authors.forename: Serafino
authors.initials: S
authors.lastname: Vanella
authors.forename: Federica
authors.initials: F
authors.lastname: Cadeddu
authors.forename: Ignazio Massimo
authors.initials: IM
authors.lastname: Civello
authors.forename: Francesco
authors.initials: F
authors.lastname: Brandara
authors.forename: Casimiro
authors.initials: C
authors.lastname: Nigro
authors.forename: Pasquale
authors.initials: P
authors.lastname: Mazzeo
authors.forename: Gaia
authors.initials: G
authors.lastname: Marniga
authors.forename: Giorgio
authors.initials: G
authors.lastname: Maria
mesh_terms: 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*