A Prospective Randomized Controlled Trial-investigate The Effect Of Anastomotic Suture On The Incidence Of Anastomotic Leakage After Laparoscopic Radical Resection Of Rectal Cancer

Objective: To investigate the effect of reinforcing suture on the incidence of anastomotic leakage after laparoscopic radical resection of rectal cancer.Methods:Three hundred patients diagnosed with rectal cancer were enrolled from September 2014 to December 2016 in Department of gastrointestinal surgery of Anhui Provincial Hospital and then randomly divided into 2 groups to receive either laparoscopic rectal resection plus reinforcing anastomosis suture(experimentgroup,n=150)or routine laparoscopic anterior resection(control group,n=150).At last,291 patients accomplished this experimental procedure.145 of them were in the experiment group and the other in the control group.Baseline demographic and clinical characteristics of the patients were well matched between the two study groups with univariate and multivariate analysis.Results: The overall incidence of anastomotic leakagein both groups was 7.5%(22/291).The incidence of anastomotic leakage was 3.6%(5/145)in the sutured group and 13.2%(17/146)in the control group.The univariate analysis showed that the difference was statistically significant(P = 0.01).Multivariate analysis represented that NRS2002 score ? 3 points,tumor diameter ? 4cm,tumor distance from the anal margin <5cm and non-consolidation of suture were independent risks of anastomotic leakage undergoing laparoscopic radical resection of rectal cancer.Afterward all patients were divided into two risk groups in terms of three high risk factors including NRS2002 score ? 3 points,tumor diameter ? 4cm and tumor distance.The high risk group was defined as accompanying with more than two high risk facts,and the low risk group defined as accompanying with no more than one high risk factor.The incidence of anastomotic leakage was 27.1%(13/48)in the high risk group while it significantly reduced to6.3%(2/32)after the reinforcing anastomotic suture(P = 0.021).In the low risk group,the incidence of anastomotic leakage was 2.7%(3/113)after the reinforcing anastomotic suture,whiletheincidence was 4.1%(4/98),without the reinforcement procedure.No statistical significance was observed(P = 0.707).Conclusion: Reinforcing suture is an independent risk factor for anastomotic leakagein patients who undergo laparoscopic radical resection of rectal cancer.Reinforcing sutures has more advantages in the patients with multiple risk factors.