QS115 - Is End-To-End or Side-To-End Anastomotic Configuration Associated with Risk of Intraoperative Air Leak in Left-Sided Colorectal Resections for Colorectal Cancer?

Sunday, June 2, 2024

10:21 AM – 10:24 AM ET, USA

Location: Room 327

Quick Shot Presenter(s)

Sami Alahmadi, MSc

Medical Student
Massachusetts General Hospital
Georgetown University
Washington, DC, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

DB

David Berger, n/a

Surgeon
MGH
Boston, Massachusetts, United States

Disclosure information not submitted.
Christy Cauley, MD, MPH (she/her/hers)

Assistant Professor
MGH
Massachusetts General Hospital; Harvard Medical School
Boston, MA, United States

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This individual has no relevant relationships with ineligible companies.
Robert N. Goldstone, MD

Colon and Rectal Surgeon
Massachusetts General Hospital
Boston, Massachusetts, United States

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This individual has no financial relationships with ineligible companies.
wk

william kastrinakis, Lecturer on Surgery

Surgeon
MGB Salem Hospital/ MGH
Beverly, Massachusetts, United States

Disclosure information not submitted.
MR

Marc Rubin, FACS, FASCRS

Assistant Professor
Harvard Medical school and Massachusetts General Hospital
Salem, Massachusetts, United States

Disclosure information not submitted.
HK

Hiroko Kunitake, MD MPH

Assistant Professor
Harvard Medical School
Boston, Massachusetts, United States

Disclosure information not submitted.
Rocco Ricciardi, MD, MPH

Chief, Section of Colon & Rectal Surgery
Massachusetts General Hospital
Boston, Massachusetts, United States

Disclosure information not submitted.

Senior Author(s)

Grace C. Lee, MD

Colorectal Surgeon
Massachusetts General Hospital
Harvard Medical School
Boston, MA, United States

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This individual has no financial relationships with ineligible companies.

Purpose/Background: Anastomotic leak following colorectal resection is associated with morbidity, mortality, and poor bowel function. There is minimal data on the potential relationship between anastomosis techniques, intraoperative leak test, and subsequent leak. A particular difference of opinion lies in the utility of performing end-to-end (EEA) versus non-end-to-end (NEEA) anastomoses to avoid postoperative leaks. This study aims to analyze if there is an association between anastomotic construction, intraoperative anastomotic assessments, and subsequent clinical leak.

Methods/Interventions: We conducted a retrospective cohort study of patients at a tertiary care center with colorectal cancer, who underwent left sided colorectal resections with colorectal, coloanal, or ileorectal anastomoses using a circular stapler. Anastomotic technique (EEA vs. NEEA) was compared. NEEA included end-to-side and side-to-end anastomoses. Primary outcomes were rates of intraoperative leak, incomplete anastomotic donuts, and postoperative clinical leak. Univariate and multivariate analysis were performed to evaluate potential association between anastomotic technique and intraoperative anastomotic assessments and subsequent leak.

Results/Outcomes: Among 872 patients who underwent left-sided colorectal resection with a circular stapled anastomosis, 27 (3.1%) had an intraoperative leak, 6 (0.7%) had incomplete donuts, and 30 (3.4%) experienced a postoperative clinical leak. A total of 514 (58.9%) patients had EEAs and 358 (41.1%) patients had NEEAs. There were no statistically significant differences in demographics or comorbidities between groups (p>0.005). EEA was associated with significantly more intraoperative air leaks than NEEAs on univariate analysis (4.8% vs 1.2%, p=0.004). There was no difference in rate of incomplete donuts (p=0.07). Even after adjusting for age, sex, obesity, ASA score, type of operation, and open approach, EEA remained significantly associated with intraoperative air leak (OR 3.6; 95% CI 1.01-12.6, p= 0.048).

There was no difference in postoperative clinical leak between EEA and NEEA on univariate analysis (2.9% vs 4.2%, p=0.31) or multivariate analysis adjusting for factors including fecal diversion (OR 0.8; 95% CI 0.4-1.8, p=0.6). Subset analysis of patients without fecal diversion also demonstrated no difference in postoperative clinical leak based on anastomotic technique. There were no statistically significant differences in rates of postoperative stricture, sepsis, readmission, reoperation, or death between the EEA and NEEA groups (p>0.05).

Conclusion/Discussion: Our data demonstrate that EEA is associated with higher rates of intraoperative air leak than NEEA, even after adjusting for potentially confounding factors. Though we found no difference in rate of postoperative anastomotic leak between the two groups, this may have been related to small sample size and lack of power, as multiple meta-analyses have shown that positive intraoperative air leak test is most closely linked to postoperative clinical leak.