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Usefulness of the one-step technique in functional end-to-end anastomosis for colonic surgery: results of a prospective multicentre cohort study from the Japanese KYCC group

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Abstract

Background

Although functional end-to-end anastomosis (FEEA) using a stapler in the colorectal field has been recognised worldwide, the technique varies by surgeon, and the safety of anastomosis using different techniques is unknown.

Methods

This multicentre prospective observational cohort study was conducted by the KYCC Study Group in Yokohama, Japan, and included patients who underwent colonic resection at seven centres between April 2020 and March 2022. This study compared the incidence of surgery-related abdominal complications (SAC: anastomotic leakage [AL], anastomotic bleeding, intra-abdominal abscess, enteritis, ileus, surgical site infection, and other abdominal complications) between two different methods of FEEA (one-step [OS] method: simultaneous anastomosis and bowel resection; two-step [TS] method: anastomosis after bowel resection). Complications of Clavien–Dindo classification grade 2 or higher were assessed.

Results

Among 293 eligible cases, the OS and TS methods were used in 194 (66.2%) and 99 (33.8%) patients, respectively. The baseline characteristics were similar between the groups. The OS method used fewer staplers (three vs. four staplers, p < 0.00001). There were no significant differences in SAC rate between the OS (19.1%) and the TS (16.2%) groups (p = 0.44). The OS group had four cases (2.1%) of AL (two patients; grade 3, two patients; grade 2) while the TS group had one case (1.0%) of grade 2 AL (p = 0.67). Multivariate logistic regression analysis showed that male sex (odds ratio [OR] 3.95; p < 0.00001), an open surgical approach (OR 2.36; p = 0.03), and longer operative duration (OR,2.79; p = 0.002) were independent predictors of complications, whereas the OS method was not an independent predictor (OR 1.17; p = 0.66).

Conclusions

The OS and the TS technique for stapled colonic anastomosis in a FEEA had a similar postoperative complication rate.

Trial registration number

UMIN000039902 (registration date 23 March 2020).

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Data availability

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

References

  1. Duan M, Wu E, ** Y et al (2023) Stapled antimesenteric functional end-to-end anastomosis following intestinal resection for Crohn’s disease. Dis Colon Rectum 66:E4–E9. https://doi.org/10.1097/DCR.0000000000002481

    Article  PubMed  Google Scholar 

  2. Kusunoki M, Yanagi H, Shoji Y, Yamamura T (1996) Modification of the stapled functional end-to-end anastomosis for ileostomy closure. Surg Today 26:1033–1035. https://doi.org/10.1007/BF00309969

    Article  CAS  PubMed  Google Scholar 

  3. Ojima H, Sohda M, Ando H et al (2015) Relationship between functional end-to-end anastomosis for colon cancer and surgical site infections. Surg Today 45:1489–1492. https://doi.org/10.1007/s00595-015-1110-x

    Article  PubMed  Google Scholar 

  4. Steichen FM (1968) The use of staplers in anatomical side-to-side and functional end-to-end enteroanastomoses. Surgery 64:948–953

    CAS  PubMed  Google Scholar 

  5. Anwar S, Hughes S, Eadie AJ, Scott NA (2004) Anastomotic technique and survival after right hemicolectomy for colorectal cancer. Surgeon 2:277–280. https://doi.org/10.1016/S1479-666X(04)80097-0

    Article  CAS  PubMed  Google Scholar 

  6. Chassin JL, Rifkind KM, Sussman B et al (1978) The stapled gastrointestinal tract anastomosis: incidence of postoperative complications compared with the sutured anastomosis. Ann Surg 188:689–696. https://doi.org/10.1097/00000658-197811000-00019

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Kano M, Hanari N, Gunji H et al (2017) Is “functional end-to-end anastomosis” really functional? A review of the literature on stapled anastomosis using linear staplers. Surg Today 47:1–7

    Article  PubMed  Google Scholar 

  8. Reiling RB, Reiling WA, Bernie WA et al (1980) Prospective controlled study of gastrointestinal stapled anastomoses. Am J Surg 139:147–152. https://doi.org/10.1016/0002-9610(80)90244-5

    Article  CAS  PubMed  Google Scholar 

  9. Yamamoto T, Keighley MRB (1999) Stapled functional end-to-end anastomosis in Crohn’s disease. Surg Today 29:679–681. https://doi.org/10.1007/BF02483001

    Article  CAS  PubMed  Google Scholar 

  10. Ritchey ML, Lally KP, Ostericher R (1993) Comparison of different techniques of stapled bowel anastomoses in a canine model. Arch Surg 128:1365–1367. https://doi.org/10.1001/archsurg.1993.01420240073014

    Article  CAS  PubMed  Google Scholar 

  11. Emoto S, Fukunaga Y, Nakanishi R et al (2022) Short- and long-term outcomes of laparoscopic surgery with extracorporeal anastomosis for transverse colon cancer: comparison of triangulating anastomosis with functional end-to-end anastomosis. Surg Endosc 36:3261–3269. https://doi.org/10.1007/s00464-021-08638-0

    Article  PubMed  Google Scholar 

  12. Ravitch MM, Ong TH, Gazzola L (1974) A new, precise, and rapid technique of intestinal resection and anastomosis with staples. Surg Gynecol Obstet 139:6–10

    CAS  PubMed  Google Scholar 

  13. Ravitch MM, Steichen FM (1972) Technics of staple suturing in the gastrointestinal tract. Ann Surg 175:815–837. https://doi.org/10.1097/00000658-197206010-00002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sato K, Imaizumi K, Kasajima H et al (2022) Short-term outcomes of extracorporeal colo-colonic triangular anastomosis versus functional end-to-end anastomosis in laparoscopic-assisted surgery for left-sided colon cancer: a propensity score matching analysis. Langenbeck’s Arch Surg 407:747–757. https://doi.org/10.1007/s00423-021-02403-6

    Article  Google Scholar 

  16. Liu Z, Wang G, Yang M et al (2014) Ileocolonic anastomosis after right hemicolectomy for colon cancer: functional end-to-end or end-to-side? World J Surg Oncol. https://doi.org/10.1186/1477-7819-12-306

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kyzer S, Gordon PH (1992) The stapled functional end-to-end anastomosis following colonic resection. Int J Colorectal Dis 7:125–131. https://doi.org/10.1007/BF00360351

    Article  CAS  PubMed  Google Scholar 

  18. Roy S, Ghosh S, Yoo A (2015) An assessment of the clinical and economic impact of establishing ileocolic anastomoses in right-colon resection surgeries using mechanical staplers compared to hand-sewn technique. Surg Res Pract 2015:1–7. https://doi.org/10.1155/2015/749186

    Article  Google Scholar 

  19. van Oostendorp S, Elfrink A, Borstlap W et al (2017) Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis. Surg Endosc 31:64–77. https://doi.org/10.1007/S00464-016-4982-Y

    Article  PubMed  Google Scholar 

  20. Allaix ME, Degiuli M, Bonino MA et al (2019) Intracorporeal or extracorporeal ileocolic anastomosis after laparoscopic right colectomy: a double-blinded randomized controlled trial. Ann Surg 270:762–767. https://doi.org/10.1097/SLA.0000000000003519

    Article  PubMed  Google Scholar 

  21. Małczak P, Wysocki M, Pisarska-Adamczyk M et al (2021) Bowel function after laparoscopic right hemicolectomy: a randomized controlled trial comparing intracorporeal anastomosis and extracorporeal anastomosis. Surg Endosc. https://doi.org/10.1007/S00464-021-08854-8

    Article  PubMed  PubMed Central  Google Scholar 

  22. Grieco M, Cassini D, Spoletini D et al (2019) Intracorporeal versus extracorporeal anastomosis for laparoscopic resection of the splenic flexure colon cancer: a multicenter propensity score analysis. Surg Laparosc Endosc Percutaneous Tech 29:483–488. https://doi.org/10.1097/SLE.0000000000000653

    Article  Google Scholar 

  23. Iguchi K, Watanabe J, Suwa Y et al (2023) The usefulness of indocyanine green fluorescence imaging for intestinal perfusion assessment of intracorporeal anastomosis in laparoscopic colon cancer surgery. Int J Colorectal Dis. https://doi.org/10.1007/s00384-023-04307-x

    Article  PubMed  Google Scholar 

  24. Zheng JC, Zhao S, Chen W et al (2021) Comparison of intracorporeal and extracorporeal anastomosis and resection in right colectomy: a systematic review and meta-analysis. Langenbeck’s Arch Surg 406:1789–1801. https://doi.org/10.1007/s00423-021-02235-4

    Article  Google Scholar 

  25. Ho YH (2010) Laparoscopic right hemicolectomy with intracorporeal anastomosis. Tech Coloproctol 14:359–363. https://doi.org/10.1007/s10151-010-0647-3

    Article  PubMed  Google Scholar 

  26. Ikeda T, Kabasima A, Ueda N et al (2012) Totally laparoscopic colectomy with intracorporeal anastomosis achieved using a laparoscopic linear stapler: experience of a single institute. Surg Today 42:41–45. https://doi.org/10.1007/s00595-011-0003-x

    Article  PubMed  Google Scholar 

  27. Bollo J, Turrado V, Rabal A et al (2020) Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial). Br J Surg 107:364–372. https://doi.org/10.1002/bjs.11389

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to express their heartfelt gratitude to Maho Sato who generous cooperation in this clinical trial. In addition, we would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, 241-8515, Japan

    K. Iguchi, S. Sato, M. Shiozawa, M. Uchiyama, S. Nukada, T. Kohmura, Y. Miakayama, Y. Ono & N. Sugano

  2. Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan

    H. Mushiake

  3. Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan

    K. Numata

  4. Department of Surgery, School of Medicine, Yokohama City University, Yokohama, Japan

    K. Kazama, M. Numata, Y. Rino & A. Saito

  5. Department of Surgery, Japanese Red Cross Hadano Hospital, Hadano, Japan

    Y. Katayama

  6. Department of Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Japan

    A. Higuchi

  7. Department of Surgery, Fujisawa Shonandai Hospital, Fujisawa, Japan

    T. Godai

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  1. K. Iguchi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Sumito Sato and Kenta Iguchi. The first draft of the manuscript was written by Kenta Iguchi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to K. Iguchi.

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Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Ethics approval

This study was approved by the institutional review board of Kanagawa Cancer Center (Number 2019-156) and each participating hospital.

Ethical approval

This investigation was conducted according to the Declaration of Helsinki and all participants provided written informed consent before enrollment.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Iguchi, K., Sato, S., Shiozawa, M. et al. Usefulness of the one-step technique in functional end-to-end anastomosis for colonic surgery: results of a prospective multicentre cohort study from the Japanese KYCC group. Tech Coloproctol 28, 82 (2024). https://doi.org/10.1007/s10151-024-02958-8

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