结肠癌切除术中δ形吻合与功能性端端吻合使用线性钉合器的短期结局比较

Short-term outcomes of delta-shaped anastomosis versus functional end-to-end anastomosis using linear staplers for colon cancer

Techniques in Coloproctology

影响因子:2.9

分区:医学3区 / 胃肠肝病学3区外科3区

发表日期:2024 Sep 23

作者: R Ono, T Tominaga, M Ishii, M Hisanaga, M Araki, Y Sumida, T Nonaka, S Hashimoto, T Shiraishi, K Noda, H Takeshita, H Fukuoka, S Oyama, K Ishimaru, T Sawai, K Matsumoto

DOI: 10.1007/s10151-024-03006-1

摘要

多种重建方法用于结肠癌手术后，包括手缝或钉合吻合。然而，关于不同重建方法的短期结局的比较报道较少。本研究对δ形吻合（Delta）与功能性端端吻合（FEEA）在短期结局方面进行了对比。回顾性分析2016年1月至2023年12月间接受结直肠手术且采用FEEA或Delta重建的1314例连续患者。根据重建方式分为F组（n = 1242）和D组（n = 72）。采用倾向评分匹配，减少选择偏倚，平衡可能影响术后并发症的协变量，比较两组的短期结局。结果显示，术后并发症在F组为215例（17.3%），在D组为8例（11.1%）。匹配前，D组中结肠横段癌更常见（p = 0.002），临床N阳性率较低（44.1%对比16.7%，p < 0.001），远处转移也较少（11.7%对比1.4%，p = 0.003），腹腔镜手术比例更高（87.8%对比100%，p < 0.001）。匹配后，组间无显著临床差异。D组的失血量显著低（28 mL对比10 mL，p = 0.002），但手术时间和术后并发症发生率相似。δ形吻合和FEEA均被认为是安全的重建方法，但仍需进一步研究以明确适用病例。

Abstract

Several methods are used for reconstruction in colon cancer surgery, including hand-sewn or stapled anastomosis. However, few reports have compared short-term outcomes among reconstruction methods. This study compared short-term outcomes between delta-shaped anastomosis (Delta) and functional end-to-end anastomosis (FEEA).We retrospectively reviewed 1314 consecutive patients who underwent colorectal surgery with FEEA or Delta reconstruction between January 2016 and December 2023. Patients were divided into two groups according to reconstruction by FEEA (F group; n = 1242) or Delta (D group; n = 72). Propensity score matching was applied to minimize the possibility of selection bias and to balance covariates that could affect postoperative complications. Short-term outcomes were compared between groups.Postoperative complications occurred in 215 patients (17.3%) in F group and 8 patients (11.1%) in D group. Before matching, transverse colon cancer was more frequent (p = 0.002), clinical N-positive status was less frequent (44.1% versus 16.7%, p < 0.001), distant metastasis was less frequent (11.7% versus 1.4%, p = 0.003), and laparoscopic approach was more frequent (87.8% versus 100%, p < 0.001) in D group. After matching, no differences in any clinical factor were evident between groups. Blood loss was significantly lower (28 mL versus 10 mL, p = 0.002) in D group, but operation time and postoperative complication rates were similar between groups.Delta and FEEA were both considered safe as reconstruction methods. Further studies are needed to clarify appropriate case selection for Delta and FEEA.