Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?

Sami Alahmadi; David L Berger; Christy E Cauley; Robert N Goldstone; William V Kastrinakis; Marc Rubin; Hiroko Kunitake; Rocco Ricciardi; Grace C Lee

doi:10.1016/j.gassur.2024.101899

Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?

J Gastrointest Surg. 2024 Nov 26:101899. doi: 10.1016/j.gassur.2024.101899. Online ahead of print.

Authors

Sami Alahmadi¹, David L Berger¹, Christy E Cauley¹, Robert N Goldstone², William V Kastrinakis³, Marc Rubin³, Hiroko Kunitake¹, Rocco Ricciardi¹, Grace C Lee⁴

Affiliations

¹ Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States.
² Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Department of Surgery, Newton-Wellesley Hospital, Newton, MA, United States.
³ Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Department of Surgery, Salem Hospital, Salem, MA, United States.
⁴ Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Department of Surgery, Salem Hospital, Salem, MA, United States. Electronic address: glee9@mgh.harvard.edu.

PMID: 39608745
DOI: 10.1016/j.gassur.2024.101899

Abstract

Background: Anastomotic leak after colorectal resection is associated with morbidity, mortality, and poor bowel function. Minimal data exist on the relationship between anastomotic technique, intraoperative leak test, and subsequent clinical leak, particularly on the utility of performing end-to-end anastomosis (EEA) vs non-EEA (NEEA) to avoid postoperative leaks. This study aimed to analyze potential associations between anastomotic construction, intraoperative anastomotic assessments, and clinical leak.

Methods: This was a retrospective cohort study comparing anastomotic techniques used in patients with colorectal cancer who underwent left-sided colorectal resections with colorectal or coloanal anastomoses at a tertiary care center. The outcomes were rates of intraoperative air leak, incomplete anastomotic donuts, and postoperative clinical leak. Univariate and multivariate analyses were performed to evaluate the potential association between anastomotic technique and intraoperative anastomotic assessments and subsequent leak.

Results: Among 844 patients, 27 (3.2%) had intraoperative leak, 6 (0.7%) had incomplete donuts, and 27 (3.2%) experienced clinical leak. Of note, 500 patients (59.2%) had EEAs, and 344 patients (40.7%) had NEEAs. There were no significant differences in demographics or comorbidities between groups (P >.05) or rates of incomplete donuts (P =.07). EEA was associated with significantly more intraoperative air leaks than NEEA on univariate analysis (4.9% vs 1.2%, respectively; P =.005) and multivariate analysis (odds ratio [OR], 3.6; 95% CI, 1.01-12.50; P =.049). There was no difference in postoperative clinical leak between the groups on univariate analysis (3.0% in EEA vs 3.5% in NEEA; P =.69) or multivariate analysis (OR, 0.97; 95% CI, 0.40-2.34; P =.94).

Conclusion: EEA is associated with higher rates of intraoperative air leak than NEEA, even after adjusting for potential confounders.

Keywords: Anastomotic leak; Colorectal anastomosis; Colorectal cancer; Colorectal surgery; Stapled anastomosis.