Comparison Of The Curative Effect Of Hand-sewn Anastomosis And Stapled Anastomosis In Laparoscopic Radical Resection Of Low Rectal Cancer

Objective: To compare the radical effects,perioperative conditions,postoperative complications and other short-term effects,anal function,3-year long-term curative effect of two different anastomotic methods using hand-sewn anastomosis and stapled anastomosis in laparoscopic radical resection of low rectal cancer,and to explore the safety and feasibility of hand-sewn anastomosis in laparoscopic radical surgery of low rectal cancer and the advantages and disadvantages of the two anastomotic methods.Methods: The clinical data of 76 patients with low rectal cancer who underwent laparoscopic radical resection in the Second Affiliated Hospital of Dalian Medical University from April 2017 to April 2019 were retrospectively analyzed.According to the different ways of anastomosis,they were divided into hand-sewn anastomosis group(32 cases,42%)and stapled anastomosis group(44 cases,58%).The radical effects,perioperative conditions,the occurrence of postoperative complications,anal function,quality of life,and long-term survival were compared between the two groups of patients.All patients were followed up until January 2021.SPSS 22.0 statistical software was used to analyze the data.Chi-square test or Fisher’s exact test were used to analysis the count data,t test or rank sum test were used to analysis the measurement data and rank sum test was used to analysis the rank data.The Kaplan-Meier method was used to analysis the 3-year overall survival,the survival curve was drawn and the difference between the two groups was compared with the log-rank test.P < 0.05 indicated that the difference was statistically significant.Results: Both groups of patients successfully completed the operation without conversion to open surgery.The median follow-up periods were 36(6～44)months,three patients(6.8%)in the stapled group died due to tumor-related factors at 12 months after follow-up.By the end of the follow-up,2 patients(6.3%)in the hand-sewn group died due to tumor-related factors,and 6 patients(13.6%)in the stapled group died due to tumor-related factors.There were no statistically significant differences between the two groups of patients’ age,gender,body mass index and other baseline data(P>0.05).The pathological results of postoperative specimens of the two groups were negative(100%),and there were no significant differences in the radical tumor resection indicators such as the distance of the distant tumor margin and the number of dissected lymph nodes(P >0.05).The operation time of the hand-sewn group and the stapled anastomosis group were 165(80～250)min and 140(90～255)min,respectively.The time of anastomosis were 14.5(9～25)min and 9(5～15)min,and the hospitalization expenses were(50156.78 ± 8087.14)yuan and(61789.56 ± 5187.67)yuan,respectively.The comparison of the above three groups of data showed statistically significant differences(P < 0.05).There were no statistically significant differences in perioperative indicators such as intraoperative blood loss,postoperative hospital stay and the time to get out of bed for the first time after surgery.The hand-sewn anastomosis group had stricture in 1 case(3.1%),and the stapled anastomosis group had strictures in 5 cases(11.4%).The stapled anastomosis group had more cases than the hand-sewn anastomosis group in stricture,but the difference was not statistically significant(P=0.377).There were no statistically significant differences in other complications such as anastomotic leakage,abdominal hemorrhage,incision infection,and Clavien-Dindo complication classification(P>0.05).The anal functions of the two groups of patients could not reach a relatively normal level at 6 months after surgery,and there were abnormal anal functions such as frequent stools,minor or major low anterior resection syndrome,and the differences were not statistically significant(P>0.05).At 12 months after surgery,the anal functions of the two groups of patients improved,the low anterior resection syndrome improved or healed spontaneously,and the frequency of defecation was lower than that of the previous.there were 0 cases(0%)and 7 cases(17.1 %)of patients with defecation difficulties in the two groups,respectively.The amounts of defecation difficulties in stapled group were higher than hand-sewn group,and the differences between the two groups were statistically significant(P=0.040).In terms of quality of life,the two groups of patients had statistically significant differences in constipation,frequent defecation and bloated feelings(P<0.05).The incidences of postoperative constipation and bloated feelings in the stapled group were higher than hand-sewn group,and the incidence of frequent defecation in the hand-sewn group was higher than stapled group.In terms of long-term efficacy,there were no significant differences in local recurrence,distant metastasis,death and 3-year overall survival between the two groups of patients(P>0.05).Conclusion: It is safe and feasible to apply hand-sewn anastomosis under the laparoscope to reconstruct the digestive tract during laparoscopic radical resection of low rectal cancer.The two methods of anastomosis showed no differences in the radical resection of tumor,short-term efficacy such as most of the perioperative indicators,the incidences of complications and the 3-year long-term efficacy.Hand-sewn anastomosis takes longer than stapled anastomosis,but the overall cost is less,and there are less difficulties in defecation and less bloated feelings after surgery in the hand-sewn group than the other group.In the treatment of low rectal cancer,hand-sewn anastomosis has a wider scope of application than stapled anastomosis,which can flexibly choose the distal resection margin and save more bowel tubes.