effect of transition to stapled anastomosis on anastomotic leak rates and operating times in colon...
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Effect of Transition to Stapled Anastomosis on Anastomotic Leak Rates
and Operating Times in Colon Cancer Surgery
Ramzi Amri,1,2 Liliana G Bordeianou,1,2 Patricia Sylla,1,2 David L Berger 1,2
1 Massachusetts General Hospital, Division of General and Gastrointestinal Surgery.2 Harvard Medical School, Department of Surgery.
02/05/159th Annual Academic Surgical Congress, February 4-6 2014
Integrated Quick Shot Session I: Oncology 3: Colorectal (10.11)
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Introduction
• Stapled GI anastomosis: easy, fast and safe• Laparoscopy has gained wide adoption• Stapling is a great tool for small port surgery• Growing adoption for CRC at MGH
Did this affect:• Complication rates?• Outcomes?
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Methods
• Colon cancer surgeries at MGH (2004-11)• Patients with primary anastomosis
(n=998)• Hand-sewn vs. stapled techniques• 2004-2007 vs. 2008-2011
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Results
NS: BMI, obesity, Charlson comorbidity
Stapled Hand-sewn P-value
N (%) Total 622 (62.3%) 376 (37.7%)
- 2004-2007 238 (45.8%) ***
282 (54.2%) ***
2008-2011 384 (80.3%) 94 (19.7%)
Age (median) Total 66 68 0.028 2004-2007 66 68 0.13 2008-2011 66 69.5 0.058
Laparoscopic (%) Total 38.1% 6.7% <0.001 2004-2007 29.8%
** 4.6%
* <0.001
2008-2011 43.3% 12.8% <0.001
Duration of surgery (M) Total 139 100 <0.001 2004-2007 147.5
*** 94
** <0.001
2008-2011 124 118.5 0.85
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Results Stapled Hand-sewn P-value
N (%) Total 622 (62.3%) 376 (37.7%)
- 2004-2007 238 (45.8%) ***
282 (54.2%) ***
2008-2011 384 (80.3%) 94 (19.7%)
Anastomotic Leak (%) Total 1.6% 2.4% 0.38
2004-2007 1.7% 2.5% 0.53
2008-2011 1.6% 2.1% 0.70
Delayed bowel function (%) Total 9.6% 10.9% 0.52
2004-2007 13.0% *
10.6% 0.40
2008-2011 7.6% 11.7% 0.19
Fascial dehiscence Total 0.6% 0.8% 1F
2004-2007 0.8% 0.7% 1F
2008-2011 0.5% 1.1% 0.56
Colonic obstruction Total 0.5% 0.3% 1F
2004-2007 0.8% 0.4% 0.59 F
2008-2011 0.3% 0% 0.85
Stay duration (M) Total 4 5 0.024
2004-2007 4 5 0.86
2008-2011 4 6 <0.001
30-day readmission (%) Total 6.4% 9.0% 0.13
2004-2007 6.3% 7.8% 0.66
2008-2011 6.5% 12.8% 0.046
F= Fischer’s exact test
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Results Covariates B (95% CI) P
Duration of surgery 2004-2007 vs. 2008-2011 (B=change in minutes)
Stapled
- univariate - -15.8 (-28.8, -2.7) 0.018
Surgeon -5.8 (-18.4, 6.7) 0.36
Laparoscopic -17.3 (-30.5, -4.1) 0.010
Hand-sewn - univariate - 21.1 (4.7, 37.5) 0.012 Laparoscopic 18.7 (2.1, 35,2) 0.027
Multivisceral 15.8 (0.4, 31.2) 0.044
Covariates OR (95% CI) P
Duration of stay ≤4 days Stapled vs. hand-sewn
Total
- univariate - 1.44 (1.12-1.87) 0.005
Charlson, Age 1.43 (1.09-1.86) 0.009 Ch. Age. DoS 1.65 (1.24-2.21) 0.001 Ch., Age, Lap. 1.03 (0.78-1.38) 0.83
Ch, Age, Lap, DoS 1.24 (0.91-1.68) 0.17
2008-2011 - univariate - 3.17 (1.91-5.25) <0.001
Ch., Age, Lap. 2.28 (1.33-3.91) 0.003 Ch., Age, Lap, DoS 2.28 (1.23-3.92) 0.003
AJCC: American Joint Committee on Cancer staging (7th edition);
Charlson/Ch: The Charlson comorbidity score, adjusted for colon cancer. DoS: Date of Surgery;
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Conclusions
In our colon cancer surgery cohort:•Stapled anastomosis had similar complication rates (if not better)•Stapled anastomosis are associated with faster discharges•Time-related changes were an important factor to account for when comparing outcomes and complications