Three Versus Two-Rows Circular Stapler in Colorectal Anastomosis: Short Term Outcomes

AimAnastomotic leakage (AL) is a significant complication after colorectal cancer surgery, with serious clinical and economic consequences. Circular staplers (CSs) with 3 staple rows of different heights may enhance anastomotic integrity and perfusion compared to conventional two-row CSs. The aim of the present study is to compare the short-term outcomes of 2 vs three-row CSs in colorectal anastomosis in case of left hemicolectomy, sigmoidectomy and anterior resection of the rectum for cancer.MethodThis is a retrospective analysis of prospectively collected data. All consecutive patients with left or sigmoid colon or rectal cancer who underwent elective resection with primary anastomosis from 2013 to 2025 were included. Patients were included in the control or in the intervention group if two-row or three-row CS was used during surgery, respectively. AL rate and its severity grade were compared between groups, and the prognostic impact of stapler type on AL onset was assessed.ResultsOne-hundred-thirty-six and 109 patients were included in the control and in the intervention group, respectively. AL rate was significantly higher in the control group in comparison to the intervention group (11.8% vs 3.7%; P = 0.02). Moreover, patients in the control group had significantly longer hospital stays than the intervention group (P = 0.04). On multivariate analysis, the use of the two-row CSs is an independent adverse predictor of AL (Odds Ratio 3.79; P = 0.03).ConclusionBased on our findings the use of three-row CS is associated with a lower postoperative AL rate and shorter LOS in comparison to the two-row CS.