Effect of Transition to Stapled Anastomosis on Anastomotic Leak Rates and Operating Times in Colon...

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)

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?

Methods

• Colon cancer surgeries at MGH (2004-11)• Patients with primary anastomosis

(n=998)• Hand-sewn vs. stapled techniques• 2004-2007 vs. 2008-2011

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

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

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;

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

Questions?

Disclosures: None.

Contact:E: ramzi_amri@harvard.eduW: hsph.me/ramri