Ban B, Shang A, Shi J. Efficacy of staple line reinforcement by barbed suture for preventing anastomotic leakage in laparoscopic rectal cancer surgery. World J Gastrointest Surg 2022; 14(8): 821-832 [PMID: 36157360 DOI: 10.4240/wjgs.v14.i8.821]
Corresponding Author of This Article
Jian Shi, MD, PhD, Associate Chief Physician, Associate Professor, Department of General Surgery, The Second Hospital of Jilin University, No. 218 Ziqiang Street, Nanguan District, Changchun 130041, Jilin Province, China. 383888697@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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World J Gastrointest Surg. Aug 27, 2022; 14(8): 821-832 Published online Aug 27, 2022. doi: 10.4240/wjgs.v14.i8.821
Table 1 Baseline characteristics of patients (n = 319)
Variables
Reinforcing sutures
P value
Yes, n = 168
No, n = 151
Age (yr)
61.8 ± 8.7
63.0 ± 9.7
0.229
Men/Women
80/88
73/78
0.897
BMI (kg/m2)
23.2 ± 3.6
22.8 ± 3.8
0.378
ASA score, n (%)
0.948
1
60 (35.7)
54 (35.8)
2
67 (39.9)
61 (40.4)
3
41 (24.4)
36 (23.8)
Tumor diameter (cm)
4.4 ± 1.7
4.1 ± 1.8
0.178
Tumor site (from anal verge, cm), n (%)
0.641
≥ 5
123 (73.2)
114(75.5)
< 5
45 (26.8)
37(24.5)
Depth of tumor invasion, n (%)
0.295
T1-T2
33 (19.6)
37 (24.5)
T3-T4
135 (80.4)
114 (75.5)
Lymph node metastases, n (%)
0.493
Yes
77 (45.8)
75 (49.7)
No
91 (54.2)
76 (50.3)
Diabetes mellitus, n (%)
31 (18.5)
22 (14.6)
0.352
Hypertension, n (%)
37 (22.0)
25 (16.6)
0.218
Heart disease, n (%)
18 (10.7)
11 (7.3)
0.287
COPD, n (%)
9 (5.4)
7 (4.6)
0.768
Previous abdominal surgery, n (%)
17 (10.1)
14 (9.3)
0.799
Preoperative CEA (ng/mL), n (%)
0.430
≥ 5
57 (33.9)
45 (29.8)
< 5
111 (66.1)
106 (70.2)
Preoperative hemoglobin levels (g/L), n (%)
0.239
≥ 90
138 (82.1)
116 (76.8)
< 90
30 (17.9)
35 (23.2)
Preoperative serum albumin level (g/L), n (%)
0.301
≥ 35
139 (82.7)
118 (78.1)
< 35
29 (17.3)
33 (21.9)
Preoperative serum CRP level (mg/L), n (%)
0.375
≥ 10
28 (16.7)
28 (20.5)
< 10
140 (83.3)
123 (79.5)
Table 2 Surgical outcomes and postoperative complications
Variables
Reinforcing sutures
P value
Yes, n = 168
No, n = 151
Left colic artery ligation, n (%)
0.637
Yes
79 (47.0)
75 (49.7)
No
89 (53.0)
76 (50.3)
Number of staple firings, n (%)
0.902
≥ 3
16 (9.5)
15 (9.9)
< 3
152 (90.5)
136 (90.1)
Operation time (min)
150.4 ± 25.1
146.6 ± 20.2
0.135
Intraoperative transfusion, n (%)
20 (11.9)
15 (9.9)
0.574
Intraoperative blood loss (mL)
60.5 ± 43.9
58.2 ± 46.3
0.652
Complications, n (%)
Anastomotic leakage
8 (4.8)
17 (11.3)
0.031
Postoperative intestinal obstruction
25 (14.9)
17 (11.3)
0.339
Anastomosis stricture
12 (7.1)
17 (13.1)
0.202
Postoperative defecation dysfunction, 3 mo
31 (18.5)
25 (16.6)
0.657
Postoperative defecation dysfunction, 6 mo
23 (13.7)
21 (13.9)
0.955
Postoperative defecation dysfunction, 12 mo
12 (7.1)
9 (6.0)
0.671
Table 3 Anastomotic leakage related indices (n = 25)
Reinforcing sutures
P value
Yes, n = 8
No, n = 17
AL classification
0.020
Grade A
3
2
Grade B
3
2
Grade C
2
13
AL time (d)
5 (2–7)
4 (1–7)
0.715
Treatment
Trans-anal lavage and drainage
2
1
0.231
Peritoneal lavage and drainage
1
1
1.000
Reoperation
2
13
0.028
Table 4 Univariate and multivariate regression on anastomotic leakage-related factors (n = 319)
Variables
Univariate regression
Multivariate regression
OR
95%CI
P value
OR
95%CI
P value
Male gender
1.189
0.523–2.705
0.680
Age ≥ 60 (yr)
2.123
0.824–5.473
0.119
BMI ≥ 25 (kg/m2)
1.115
0.448–2.775
0.814
Diabetic mellitus
2.604
1.060–6.394
0.037
1.662
0.588–4.669
0.338
Hypertension
1.039
0.374–2.888
0.941
Heart disease
2.050
0.652–6.441
0.219
COPD
1.739
0.372–8.124
0.482
Low tumor location < 5 (cm)
2.954
1.289–6.769
0.010
2.856
1.133–7.198
0.026
Tumor diameter ≥ 4 (cm)
3.010
1.313–6.901
0.009
2.994
1.185–7.563
0.020
T3-T4
1.135
0.410–3.142
0.807
Lymph node metastases
1.719
0.748–3.951
0.202
Previous laparotomy
1.884
0.602–5.890
0.276
Preoperative CEA ≥ 5 (ng/mL)
1.216
0.518-2.852
0.653
Preoperative serum albumin level < 35 (g/L)
1.690
0.673–4.244
0.264
Preoperative hemoglobin levels < 90 (g/L)
1.582
0.631–3.967
0.328
Preoperative serum CRP level, ≥ 10 (mg/L)
2.242
0.918–5.476
0.076
ASA score ≥ 3
1.244
0.499–3.102
0.639
Ligation of left colic artery
2.435
1.019–5.819
0.045
2.195
0.869–5.546
0.096
Operation time ≥ 150 (min)
2.437
1.059–5.613
0.036
1.837
0.750–4.495
0.183
Number of staple firings ≥ 3
2.577
0.893–7.434
0.080
Intraoperative transfusion
1.116
0.316–3.939
0.864
Intraoperative blood loss ≥ 60 (mL)
1.223
0.537–2.787
0.632
Reinforcing sutures
0.394
0.165–0.942
0.036
0.293
0.114–0.750
0.010
Postoperative intestinal obstruction
2.263
0.848–6.041
0.103
Table 5 Subgroup analysis of the effectiveness of reinforcing sutures
Reinforcing sutures
Anastomotic leakage
P value
Yes
No
Low-risk group
0.368
Yes
1
87
No
4
85
High-risk group
0.038
Yes
7
73
No
13
49
Citation: Ban B, Shang A, Shi J. Efficacy of staple line reinforcement by barbed suture for preventing anastomotic leakage in laparoscopic rectal cancer surgery. World J Gastrointest Surg 2022; 14(8): 821-832