The post-operative impact of oversewing stapled anastomoses in colorectal cancer surgery: A retrospective Australian cohort study

Background: To assess the effect of oversewing double stapled anastomoses (DSA) on clinical outcomes in colorectal cancer surgery, including the rates of anastomotic leak and bleeding. Materials and methods: A retrospective analysis of prospectively collected data from two Victorian hospitals was performed on patients having had a colorectal cancer resection between January 2010 and July 2017. Patients with oversewn anastomoses were compared with those patients where no oversewing was performed. Complications (surgical and medical) were investigated using logistic regression. Further subgroup analyses on colonic resections were performed. Results: Analysis of the eligible 2001 patients demonstrated that patients with an oversewn DSA were less likely to have an anastomotic leak (p = 0.03), or return to theatre (p = 0.014). An oversewn DSA did not influence in-patient mortality, 30-day mortality or other surgical complications. Univariate analysis showed anastomotic leaks were less likely for oversewn patients and females but more likely with rectal cancers, open surgery or laparoscopic converted to open surgery, and increasing BMI. Subgroup analysis of the 884 colonic resections demonstrated oversewn patients were less likely to return to theatre (OR 0.250, 95%CI 0.070–0.893), have medical complications (OR 0.298, 95%CI 0.106–0.842) or a small bowel obstruction (OR 0.087, 95%CI 0.009–0.820). Univariate analysis showed hybrid or laparoscopic surgery, left side tumours, and a history of arrhythmia increased risk of anastomotic leak for colonic resections. Multivariate analysis showed all these factors had independent associations with anastomotic leak. Conclusion: Oversewing a double-stapled anastomoses in colorectal cancer surgery is a protective factor against anastomotic leaks and reduces reoperative surgery rates.