Clinical impact of the triple‐layered circular stapler for reducing the anastomotic leakage in rectal cancer surgery: Porcine model and multicenter retrospective cohort analysis

• Published in: Annals of gastroenterological surgery Vol. 6; no. 2; pp. 256 - 264
• Main Authors: Nakanishi, Ryota, Fujimoto, Yoshiaki, Sugiyama, Masahiko, Hisamatsu, Yuichi, Nakanoko, Tomonori, Ando, Koji, Ota, Mitsuhiko, Kimura, Yasue, Oki, Eiji, Yoshizumi, Tomoharu
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.03.2022; John Wiley and Sons Inc; Wiley
• Subjects: Abdomen; anastomotic leak; Cancer surgery; Cohort analysis; Colorectal cancer; colorectal surgery; Fecal incontinence; Original; Ostomy; postoperative complications; rectal neoplasms; Rectum; Small intestine; Statistical analysis; Surgeons; surgical instruments; Japan; postoperative complications; rectal neoplasms; colorectal surgery; surgical instruments; anastomotic leak
• ISSN: 2475-0328; 2475-0328
• DOI: 10.1002/ags3.12516

Aim To investigate the impact of the triple‐layered circular stapler compared with the double‐layered circular stapler on anastomotic leakage after rectal cancer surgery. Methods The bursting pressure was compared between porcine ileocolic anastomoses created using a double‐ or triple‐layered stapler. We also retrospectively analyzed the incidence of severe anastomotic leakage in 194 patients who underwent colorectal anastomosis using a double‐ or triple‐layered circular stapler during rectal cancer resection performed in two cancer centers between January 2015 and April 2021. Results In the porcine model, the bursting pressure was higher in anastomoses created using the triple‐layered stapler than the double‐layered stapler (end‐to‐end anastomosis: 26.4 ± 6.2 mm Hg vs 14.5 ± 4.3 mm Hg, P = .0031; side‐to‐side anastomosis: 27.7 ± 5.0 mm Hg vs 18.0 ± 2.9 mm Hg, P = .0275). Intersectional leakage occurred in 41% and 83% of anastomoses created using the triple‐ or double‐layered stapler, respectively (P = .0821). In the clinical cohort, the double‐ and triple‐layered stapler was used in 153 and 41 patients, respectively. The incidence of anastomotic leakage was lower for anastomoses created using the triple‐layered stapler vs the double‐layered stapler (0.0% vs 5.8%, P = .0362). In multivariate analysis, the factors independently associated with a lower incidence of anastomotic leakage were female sex (odds ratio: 0.16, 95% confidence interval: 0.01‐0.90, P = .0354) and triple‐layered stapler usage (odds ratio: 0.00, 95% confidence interval: 0.00‐0.96, P = .0465). Conclusion Anastomoses created using a triple‐layered circular stapler had high bursting pressure, which might contribute to a lower incidence of anastomotic leakage after rectal cancer surgery. In the porcine model, anastomoses created using the triple‐layered circular stapler had higher bursting pressure than the double‐layered stapler. Furthermore, in the multicenter clinical cohort, the use of the triple‐layered circular stapler was independently associated with the absence of anastomotic leakage.