Three-row versus two-row circular staplers for left-sided colorectal anastomosis: a propensity score-matched analysis of the iCral 2 and 3 prospective cohorts

Marco Catarci, Stefano Guadagni, Francesco Masedu, Giacomo Ruffo, Massimo G. Viola, Felice Borghi, Gianandrea Baldazzi, Marco Scatizzi, Felice Pirozzi, Paolo Delrio, Gianluca Garulli, Pierluigi Marini, Roberto Campagnacci, Raffaele De Luca, Ferdinando Ficari, Giuseppe Sica, Gigliola Sica, Stefano Scabini, Andrea Liverani, Marco CaricatoAlberto Patriti, Stefano Mancini, Gian Luca Baiocchi, Roberto Santoro, Walter Siquini, Gianluca Guercioni, Massimo Basti, Corrado Pedrazzani, Mauro Totis, Alessandro Carrara, Andrea Lucchi, Maurizio Pavanello, Andrea Muratore, Stefano D’Ugo, Alberto Di Leo, Giusto Pignata, Ugo Elmore, Gabriele Anania, Massimo Carlini, Francesco Corcione, Nereo Vettoretto, Graziano Longo, Giulia Longo, Mario Sorrentino, Giovanni Ferrari, Lucio Taglietti, Augusto Verzelli, Mariantonietta Di Cosmo, Davide Cavaliere, Marco Milone, Maria Milone, Stefano Rausei, Giovanni Ciaccio, Giovanni Tebala, Giuseppe Brisinda, Stefano Berti, Paolo Millo, Luigi Boni, Mario Guerrieri, Roberto Persiani, Dario Parini, Antonino Spinelli, Michele Genna, Vincenzo Bottino, Andrea Coratti, Dario Scala, Umberto Rivolta, Micaela Piccoli, Carlo Talarico, Franco Roviello, Alessandro Anastasi, Giuseppe Maria Ettorre, Mauro Montuori, Pierpaolo Mariani, Nicolò De Manzini, Annibale Donini, Mariano Fortunato Armellino, Carlo Feo, Silvio Guerriero, Silvia Guerriero, Andrea Costanzi, Federico Marchesi, Moreno Cicetti, Paolo Ciano, Michele Benedetti, Leonardo Antonio Montemurro, Maria Sole Mattei, Elena Belloni, Daniela Apa, Matteo Di Carlo, Miriam Di Carlo, Marco Clementi, Elisa Bertocchi, Gaia Masini, Amedeo Altamura, Gerardo Andrea Altamura, Francesco Rubichi, Desirée Cianflocca, Marco Migliore, Diletta Cassini, Lorenzo Pandolfini, Alessandro Falsetto, Antonio Sciuto, Ugo Pace, Andrea Fares Bucci, Francesco Monari, Grazia Maria Attinà, Angela Maurizi, Michele Simone, Francesco Giudici, Fabio Cianchi, Gabriele Baldini, Bruno Sensi, Alessandra Aprile, Domenico Soriero, Andrea Scarinci, Gabriella Teresa Capolupo, Valerio Sisti, Marcella Lodovica Ricci, Andrea Sagnotta, Sarah Molfino, Pietro Amodio, Alessandro Cardinali, Simone Cicconi, Irene Marziali, Diletta Frazzini, Cristian Conti, Nicolò Tamini, Marco Braga, Matteo Braga, Michele Motter, Giuseppe Tirone, Giacomo Martorelli, Alban Cacurri, Carlo Di Marco, Carmine Di Marco, Patrizia Marsanic, Nicoletta Sveva Pipitone Federico, Marcello Spampinato, Lorenzo Crepaz, Jacopo Andreuccetti, Ilaria Canfora, Giulia Maggi, Matteo Chiozza, Domenico Spoletini, Rosa Marcellinaro, Giorgio Lisi, Umberto Bracale, Roberto Peltrini, Maria Michela Di Nuzzo, Emanuele Botteri, Simone Santoni, Massimo Stefanoni, Giovanni Del Vecchio, Carmelo Magistro, Silvia Ruggiero, Sara Ruggiero, Arianna Birindelli, Andrea Budassi, Daniele Zigiotto, Leonardo Solaini, Giorgio Ercolani, Giovanni Domenico De Palma, Silvia Tenconi, Paolo Locurto, Antonio Di Cintio, Maria Michela Chiarello, Maria Cariati, Andrea Gennai, Manuela Grivon, Elisa Cassinotti, Monica Ortenzi, Michela Ortenzi, Alberto Biondi, Maurizio De Luca, Francesco Carrano, Francesca Fior, Antonio Ferronetti, Giuseppe Giuliani, Graziella Marino, Camillo Leonardo Bertoglio, Francesca Pecchini, Vincenzo Greco, Viviana Greco, Roberto Piagnerelli, Giuseppe Canonico, Marco Colasanti, Enrico Pinotti, Roberta Carminati, Edoardo Osenda, Luigina Graziosi, Ciro De Martino, Giovanna Ioia, Fioralba Pindozzi, Lorenzo Organetti, Michela Monteleone, Giorgio Dalmonte, Gabriele La Gioia

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Background: Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to analyze the effect of a three-row circular stapler on anastomotic leakage and related morbidity after left-sided colorectal resections. Materials and methods: A circular stapled anastomosis was performed in 4255 (50.9%) out of 8359 patients enrolled in two prospective multicenter studies in Italy, and, after exclusion criteria to reduce heterogeneity, 2799 (65.8%) cases were retrospectively analyzed through a 1:1 propensity score-matching model including 20 covariates relative to patient characteristics, to surgery and to perioperative management. Two well-balanced groups of 425 patients each were obtained: group (A) – true population of interest, anastomosis performed with a three-row circular stapler; group (B) – control population, anastomosis performed with a two-row circular stapler. The target of inferences was the average treatment effect in the treated (ATT). The primary endpoints were overall and major anastomotic leakage and overall anastomotic bleeding; the secondary endpoints were overall and major morbidity and mortality rates. The results of multiple logistic regression analyses for the outcomes, including the 20 covariates selected for matching, were presented as odds ratios (OR) and 95% confidence intervals (95% CI). Results: Group A versus group B showed a significantly lower risk of overall anastomotic leakage (2.1 vs. 6.1%; OR 0.33; 95% CI 0.15–0.73; P = 0.006), major anastomotic leakage (2.1 vs. 5.2%; OR 0.39; 95% CI 0.17–0.87; P = 0.022), and major morbidity (3.5 vs. 6.6% events; OR 0.47; 95% CI 0.24–0.91; P = 0.026). Conclusion: The use of three-row circular staplers independently reduced the risk of anastomotic leakage and related morbidity after left-sided colorectal resection. Twenty-five patients were required to avoid one leakage.
Lingua originaleEnglish
pagine (da-a)2312-2323
Numero di pagine12
RivistaInternational Journal of Surgery
Volume109
DOI
Stato di pubblicazionePubblicato - 2023

Keywords

  • anastomotic leakage
  • colorectal surgery
  • circular staplers

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