Anastomotic Leakage In Laparoscopic Anterior Resection With Or Without "dog Ear" Double-stapled Anastomosis For Rectal Cancer

Objective:Compare with the traditional double stapling technique(DST),to investigate the technique of "dog ear" resection in laparoscopic anterior resection of rectal cancer(modified double stapler technique,MDST)in patients with middle and high rectal cancer.The effect of MDST on the incidence of anastomotic leakage after operation.Methods:We prospectively collected clinical data of 197 patients for middle and high rectal cancer from September 2015 to October 2018.They were randomly divided into experimental group(MDST group)and control group(DST group).There were 99 cases in MDST group and 98 cases in DST group.Comparing the two groups of patients preoperative clinical basic data,postoperative pathological data,postoperative hospitalization days,incidence of anastomotic leakage and anastomotic bleeding,and reoperation rate.The risk factors of postoperative anastomotic leakage were analyzed by Logistic univariate and multivariate analysis.A P value <0.05 was considered statistically significant.Results:(1)Comparison of preoperative basic clinical features: The average age(64.1±9.6Y vs.59.2 ± 10.4Y,P=0.001),the proportion of male patients(63.6% vs.48.0%,P=0.027),the preoperative hemoglobin(137.1 ± 15.5g/L vs.131.5 ±16.6g/L,P=0.015),the proportion of patients with smoking history(44.4% vs.29.6%,P=0.031)in MDST group were higher than those in DST group,but the proportion of patients with diabetes history in MDST group was lower than that in DST group(9.1% vs.20.4%,P=0.025).Body mass index,ASA rating,preoperative albumin,drinking history,hypertension history,abdominal surgery history,distance from tumor to anal margin,tumor marker levels(CEA,CA199),and preoperative clinical staging no significant difference(P>0.05).(2)Comparison of intraoperative conditions:Surgical time,intraoperative blood loss,anastomotic distance from the anus marginal distance,distal margin length,proximal margin length,operative method,anal drainage tube no significant difference(P>0.05).(3)Postoperative recovery:The first exhaust time,the first defecation time,the first eating fluid time,the time of returning to normal diet and the days of postoperative hospitalization in MDST group were better than those in DST group,but there was no significant difference between the two groups(P > 0.05).(4)Surgical safety:The incidence of complications in MDST group and DST group was 10.1% and 13.3% respectively.The incidence of anastomotic leakage in MDST group was lower than that in DST group(4.0% vs.7.1%).The incidence of grade B anastomotic leakage in MDST group was lower than that in DST group(2.0% vs.5.1%),C grade anastomotic leakage was the same as that in DST group(2.0% vs.2.0%),but the incidence of anastomotic bleeding was higher than that in DST group(3.0% vs.1.0%),and there was no significant difference between the two groups(P > 0.05).However,there was no significant difference between the two groups(P > 0.05).There was no significant difference in the incidence of surgical relative complications such as intestinal obstruction,pelvic infection,pulmonary infection,urinary tract infection and drainage fluid bacterial culture between the two groups(P > 0.05).The reoperation rate in the experimental group and the control group were both 2%.(5)Postoperative pathology:The p T stage in the MDST group was earlier than that in the DST group(P=0.045).The number of positive lymph nodes,nerve invasion,vascular tumor thrombus,pathological gross type,differentiation degree,histological type、p N stage,p TNM stage,positive rate of distal margin between the two groups were not statistically significant(P>0.05).Logistic univariate and multivariate suggested that age(OR:0.944,95%CI:0.894-0.996,P=0.036)and tumor length(OR:1.527,95%CI:1.090-2.139,P=0.014)were the independent risk factor for anastomotic leakage after laparoscopic anterior resection of rectal cancer in patients with middle and high rectal cancer,but stapler technique is not a risk factor.Conclusion:1.The modified double stapling technique(MDST)and the traditional double stapling technique(DST)were safe and feasible surgical methods.However,compared with DST,MDST has a better trend in reducing anastomotic leakage and postoperative complications.2.The age ang the length of tumor were the independent risk factor for anastomotic leakage after laparoscopic anterior resection of rectal cancer in patients with middle and high rectal cancer.