Postoperative Outcomes After Rectal Cancer Surgery With or Without Primary Anastomosis: A Propensity Score-Weighted...

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Clinical Outcomes Research

Background:

• The role of primary anastomosis in rectal cancer surgery is debated due to postoperative morbidity concerns.
• Limited randomized trial evidence and selection bias in observational studies hinder definitive conclusions.

Purpose of the Study:

• To compare postoperative outcomes between rectal cancer patients with and without primary anastomosis.
• To assess the impact of primary anastomosis on complications, reintervention, mortality, and resource utilization.

Main Methods:

• Retrospective observational study of 173 rectal cancer patients.
• Propensity score overlap weighting to adjust for confounding factors.
• Analysis of postoperative complications, severe complications, reintervention, mortality, and healthcare resource utilization.

Main Results:

• No significant difference in overall postoperative complications between groups (RD +0.01, 95% CI -0.14 to +0.17).
• Numerically higher severe complications and lower reinterventions with primary anastomosis, but not statistically significant.
• Significantly lower in-hospital mortality in the primary anastomosis group (RD -0.08, 95% CI -0.16 to -0.02).

Conclusions:

• Postoperative outcomes are comparable with or without primary anastomosis in rectal cancer surgery after statistical adjustment.
• Findings suggest individualized decision-making rather than a routine approach for restorative or non-restorative strategies.
• Residual confounding and surgical selection warrant cautious interpretation of results.