Randomized Controlled Trial Comparative Study in Powered and Manual Stapler in Low Anterior Resection of Rectal...

Area of Science:

• Colorectal surgery
• Surgical oncology
• Gastrointestinal oncology

Background:

• Anastomotic leakage is a major complication after low anterior resection (LAR) for rectal cancer.
• Powered circular staplers (PCS) aim to improve consistency in LAR, but their superiority over manual circular staplers (MCS) is unproven.

Purpose of the Study:

• To compare the efficacy of PCS versus MCS in reducing anastomotic leakage after LAR for rectal cancer.
• To identify risk factors for anastomotic leakage in patients undergoing LAR.

Main Methods:

• A randomized controlled trial included 170 patients undergoing LAR for mid-to-low rectal cancer.
• Patients were randomized to either MCS or PCS.
• Outcomes including anastomotic leakage and risk factors were analyzed using multivariate logistic regression.

Main Results:

• No significant difference in anastomotic leakage rates between PCS (13.2%) and MCS (5.1%) groups (p=0.112).
• PCS group had higher estimated blood loss and longer operative times.
• A longer interval between neoadjuvant chemoradiotherapy (CRT) completion and surgery was a significant independent risk factor for leakage.

Conclusions:

• Current evidence does not support PCS superiority over MCS in preventing anastomotic leakage after LAR.
• Optimizing the timing of surgery post-neoadjuvant CRT is crucial for reducing leakage risk.
• Further studies are needed to clarify stapler impact in high-risk populations and optimal post-CRT surgical timing.