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

Anastomotic leakage remains one of the most serious complications following low anterior resection (LAR) for rectal cancer. While powered circular staplers (PCS) have been introduced to improve surgical consistency and reduce technical errors, their clinical superiority over manual circular staplers (MCS) remains unclear.

A randomized controlled trial was conducted from December 2022 to April 2025, enrolling 179 patients with mid-to-low rectal cancer scheduled for LAR. After applying exclusion criteria, 170 patients were included in the final analysis (79 in the MCS group and 91 in the PCS group). Baseline characteristics, intraoperative findings, and postoperative outcomes were compared. Multivariate logistic regression was used to identify risk factors for anastomotic leakage.

There were no statistically significant differences between groups in terms of overall complication rates or intraoperative outcomes, although the PCS group demonstrated higher estimated blood loss and longer operative time. The incidence of anastomotic leakage was higher in the PCS group (13.2%) compared to the MCS group (5.1%), though this difference did not reach statistical significance (p = 0.112). Notably, a longer interval between completion of neoadjuvant chemoradiotherapy (CRT) and surgery was significantly associated with increased leakage risk (mean: 16.90 vs. 10.97 weeks; p < 0.001). Multivariate analysis confirmed that extended time to surgery after CRT was an independent risk factor for anastomotic leakage.

Although the PCS group showed a trend toward higher anastomotic leakage rates, the difference was not statistically significant. The interval between CRT completion and surgery emerged as a significant predictor of leakage. Further research is needed to establish optimal timing for surgery post-CRT and to determine whether stapler type influences outcomes in high-risk patients.