Usefulness of a powered circular stapler compared with a manual circular stapler in patients undergoing colorectal cancer surgery: A retrospective cohort study and systematic review

Abstract

Postoperative complications related to anasto‑ mosis, including postoperative anastomotic bleeding and anastomotic leakage, remain a serious issue. The effect of anastomotic devices on suture complications during intestinal anastomosis remains unclear. The present study examined the utility of automated anastomotic devices for reducing anastomotic complication risks. A retrospective cohort study of colorectal cancer surgeries in which an anastomosis device was used at Osaka University Hospital (Suita, Japan) between January 2018 and December 2022 was conducted. Cases of emergency surgery, inflammatory bowel disease and simultaneous surgery for other cancers were excluded. Experienced gastrointestinal surgeons performed manual anastomosis using the ETHICON Circular Stapler CDH or EEA Circular Stapler, and automatic anastomosis using the ECHELON CIRCULAR Powered Stapler, with no observed operator bias. Additionally, a meta‑analysis that included other study results was performed. The outcomes included postoperative complications, mainly anastomotic leakage. The study included 414 patients: 183 in the manual circular stapler group and 231 in the powered circular stapler (PCS) group. Although this retrospective study found no statisti‑ cally significant association between the anastomotic device used and anastomotic complications, an increased risk ratio was observed in the manual group compared with the auto‑ matic group when restricted to elderly patients. Similarly, a meta‑analysis found a significantly higher anastomotic complication risk in the manual group compared with the automatic group (random‑effects model; odds ratio, 0.376; 95% confidence interval, 0.232‑0.610; P<0.0001). The find‑ ings of the present study suggested that a PCS is useful for reducing the anastomotic complication risk in patients under‑ going colorectal cancer surgery.