Safety and efficiency of side-to-end anastomosis versus straight colorectal anastomosis in low anterior resections

doi:10.3877/cma.j.issn.2095-3224.2021.04.007

Abstract

Abstract:

Objective

It is yet to be clarified whether side to end anastomosis (SEA) for low anterior resections (LAR) will bring the risk of radical tumor resection, whether it will increase the incidence of postoperative complications, and how much is the benefit of the defecation function for patients after surgery. This meta-analysis aims to evaluate the efficacy and safety of SEA for LAR.

Methods

The Chinese and English literatures published between October 1997 and January 2021 about SEA for rectal cancer were searched from PubMed, Embase, The Cochrane Library, Web of Science, CNKI net and Wanfang database. This Meta-analysis was performed using Review Manager 5.4.

Results

A total of 225 literatures were retrieved, and 7 literatures were enrolled finally. A total of 552 patients were enrolled, including 284 in SCA group and 268 in SEA group. The meta-analysis of the safety indicators showed that there was significant differences in pelvic sepsis (OR=0.18, 95%CI: 0.05~0.66; P=0.01), while there were no significant differences in operation time(OR=1.28, 95%CI: -3.75~6.30; P=0.62), protective stoma(OR=3.52, 95%CI: 0.55~22.66; P=0.19), anastomotic leakage(OR=0.50, 95%CI: 0.23~1.08; P=0.08) anastomotic bleeding (OR=1.08, 95%CI: 0.26~4.44; P=0.92), wound infection(OR=0.64, 95%CI: 0.28~1.50; P=0.31), wound dehiscence(OR=1.27, 95%CI: 0.44~3.64; P=0.65)and pneumonia (OR=0.80, 95%CI: 0.27~2.38; P=0.68). The meta-analysis of the efficacy indicators showed that there was significant differences in nocturnal incontinence (OR=0.35, 95%CI: 0.14~0.85; P=0.02) while there were no significant differences in "use of antidiarrheal medicine" (OR=0.79, 95%CI: 0.34~1.82; P=0.58)、"urgency" (OR=0.41, 95%CI: 0.12~1.34; P=0.14)、"need to wear a pad" (OR=0.59, 95%CI: 0.24~1.48; P=0.26)、"differentiation between flatus and feces" (OR=0.75, 95%CI: 0.27~2.12; P=0.59).

Conclusions

In low anterior resections, SEA for reconstruction can reduce the incidence of nocturnal incontinence 6 months after surgery and the incidence of postoperative pelvic abscess. The safety and efficiency of SEA is definite and SEA can be used for bowel reconstruction during low anterior resections.

Key words: Rectal neoplasms, Low anterior resections, Side to end anastomosis, Straight colorectal anastomosis, Meta-analysis

Sen Hou, Shidong Zhao, Fan Liu, Yingjiang Ye. Safety and efficiency of side-to-end anastomosis versus straight colorectal anastomosis in low anterior resections[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(04): 371-378.

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Figures/Tables 12

References 28

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作者	发表年份	国家	研究类型	SCA组	SEA组	性别（男/女）		平均年龄（岁）		肿瘤高度（cm）		吻合口高度（cm）		质量评分
作者	发表年份	国家	研究类型	SCA组	SEA组	SCA组	SEA组	SCA组	SEA组	SCA组	SEA组	SCA组	SEA组	质量评分
Tsunoda等^［14］	2008	日本	RCT	13	17	9/4	11/6	63	62	-	-	5.7	4	4
Brisinda等^［13］	2009	意大利	RCT	37	40	20/17	19/21	63.7	67.0	-	-	-	-	4
Zhang等^［12］	2011	中国	CCT	30	15	16/14	8/7	54	53	6	6	-	-	7
陈涛等^［11］	2013	中国	CCT	30	30	19/11	18/12	64	62	5.5	5.5	3.4	3.5	7
Rybakov等^［10］	2016	俄罗斯	RCT	40	41	20/20	13/28	63	61	8.5	8.4	5.1	4.8	5
Marti等^［9］	2019	瑞士	RCT	99	95	67/32	62/33	66.3	67.2	5	7	-	-	6
Planellas等^［8］	2021	西班牙	RCT	35	30	23/12	17/13	68	64	-	-	6.7	6.1	5

作者	发表年份	国家	研究类型	SCA组	SEA组	性别（男/女）		平均年龄（岁）		肿瘤高度（cm）		吻合口高度（cm）		质量评分
作者	发表年份	国家	研究类型	SCA组	SEA组	SCA组	SEA组	SCA组	SEA组	SCA组	SEA组	SCA组	SEA组	质量评分
Tsunoda等^［14］	2008	日本	RCT	13	17	9/4	11/6	63	62	-	-	5.7	4	4
Brisinda等^［13］	2009	意大利	RCT	37	40	20/17	19/21	63.7	67.0	-	-	-	-	4
Zhang等^［12］	2011	中国	CCT	30	15	16/14	8/7	54	53	6	6	-	-	7
陈涛等^［11］	2013	中国	CCT	30	30	19/11	18/12	64	62	5.5	5.5	3.4	3.5	7
Rybakov等^［10］	2016	俄罗斯	RCT	40	41	20/20	13/28	63	61	8.5	8.4	5.1	4.8	5
Marti等^［9］	2019	瑞士	RCT	99	95	67/32	62/33	66.3	67.2	5	7	-	-	6
Planellas等^［8］	2021	西班牙	RCT	35	30	23/12	17/13	68	64	-	-	6.7	6.1	5

手术并发症	研究数量	纳入人数	统计方法	效应量	P值	异质性
手术并发症	研究数量	纳入人数	统计方法	效应量	P值	I²	P值
切口感染	2	137	Odds Ratio（M-H，Fixed，95%CI）	0.64（0.28~1.50）	0.31	0%	0.48
切口哆开	2	137	Odds Ratio（M-H，Fixed，95%CI）	1.27（0.44~3.64）	0.65	0%	0.66
肺部感染	2	137	Odds Ratio（M-H，Fixed，95%CI）	0.80（027~2.38）	0.68	0%	0.65
尿潴留	2	158	Odds Ratio（M-H，Fixed，95%CI）	1.20（0.31~4.46）	0.80	0%	0.79

手术并发症	研究数量	纳入人数	统计方法	效应量	P值	异质性
手术并发症	研究数量	纳入人数	统计方法	效应量	P值	I²	P值
切口感染	2	137	Odds Ratio（M-H，Fixed，95%CI）	0.64（0.28~1.50）	0.31	0%	0.48
切口哆开	2	137	Odds Ratio（M-H，Fixed，95%CI）	1.27（0.44~3.64）	0.65	0%	0.66
肺部感染	2	137	Odds Ratio（M-H，Fixed，95%CI）	0.80（027~2.38）	0.68	0%	0.65
尿潴留	2	158	Odds Ratio（M-H，Fixed，95%CI）	1.20（0.31~4.46）	0.80	0%	0.79

排粪功能	研究数量	纳入人数	统计方法	效应量	P值	异质性
排粪功能	研究数量	纳入人数	统计方法	效应量	P值	I²	P值
排粪急迫	2	109	Odds Ratio（M-H，Fixed，95% CI）	0.41（0.12~1.34）	0.14	0%	0.44
使用会阴垫	2	125	Odds Ratio（M-H，Fixed，95% CI）	0.59（0.24~1.48）	0.26	0%	0.51
区分排气排粪	2	74	Odds Ratio（M-H，Fixed，95% CI）	0.75（0.27~2.12）	0.59	0%	0.68

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