Influences of the anastomotic technique in right-sided hemicolectomy on the early postoperative outcome: data from the DGAV StuDoQ|ColonCancer registry

Background:

Despite recent improvements in colon cancer surgery, the rate of anastomotic leakage (AL) after right hemicolectomy is surprisingly high. This study examines whether anastomosis technique (hand-sewn, stapled) after right hemicolectomy for right-sided colon cancer impacts postoperative complications.

Method:

Patients prospectively documented in the German Society for General and Visceral Surgery StuDoQ registry from 2010 till 2017 were retrospectively analysed. Univariate and multivariate analysis were performed. Primary endpoint was AL, secondary endpoints were postoperative ileus, complications, and length of postoperative hospital stay (LOS).

Results:

A total of 4062 patients who had undergone right hemicolectomy for colon cancer were analysed. All patients received ileocolic anastomoses, 2742 were hand-sewn, 1320 stapled. Baseline characteristics were similar, although patients in the hand-sewn group were one year younger and had slightly better performance status. The two groups did not differ regarding major postoperative outcomes like AL, postoperative ileus, reoperation rate, surgical site infection or death. The stapled group had a significantly shorter operation time, and fewer minor complications (Clavien-Dindo classification grades 1 and 2); LOS did not differ. Multivariate logistic regression analyses found known factors such as ASA score, BMI and extended resection to be significantly associated with postoperative complications, but anastomosis technique was not.

Conclusion:

Hand-sewn anastomosis and stapled ileo-colostomy for right hemicolectomy for right-sided colon cancer are equally safe in terms of postoperative complications. Use of any stapler, however, is associated with reduced operation time and significantly fewer minor (CDC 1 and 2) complications.