Does robotic circumferential oversewing reduce anastomotic leakage in stapled anastomosis for rectal cancer surgery?

Anastomotic leakage (AL) remains a challenging complication of rectal cancer surgery. In patients diagnosed with low risk of AL, low anterior resection (LAR) is often performed without creating a stoma. However, AL can still occur even in patients considered to be at low risk. This study assessed the effects of circumferential oversewing (CO) on AL in patients undergoing robotic LAR without fecal diversion.

We retrospectively reviewed data from 225 patients with rectal cancer who underwent robotic LAR without fecal diversion. They were divided into CO and non-CO groups. The CO group received oversewing along the circular staple line. The AL rate was assessed after the inverse probability of treatment weighting (IPTW) adjustments.

After IPTW adjustment, no significant differences in baseline characteristics were observed between the two groups. Overall complication and AL rates were 12.0% and 4.5%, respectively. Although no difference in overall complications was observed between the two groups, patients in the CO group had a significantly lower AL rate than the non-CO group (1.7% vs. 10.3%, p = 0.010). Logistic regression analysis revealed that the CO procedure was a protective factor against AL (IPTW-adjusted OR 0.153, 95% CI 0.036-0.643, p = 0.010).

The application of the CO procedure in patients with LAR who were not indicated for stoma creation may contribute to reducing the risk of AL.