Abstract
Between 1978 and 1981, 73 patients with colonic or rectal cancer were randomized to have their anastomoses made by either a single interrupted layer of braided polyester sutures, or by a circular stapling instrument. Of these operations, 20 were considered to have been palliative, the remaining 53 being potentially curative. The incidence of local recurrence in the latter group was analyzed in relation to initial septic and anastomotic complications. The 53 patients were followed for a median of 36 months (range, 1 to 87); 24 were alive and well and 22 had died of disseminated cancer or unrelated causes. Seven patients died with local recurrent disease proved at laparotomy or autopsy after a median of 33 months (range, 3 to 72). Thirty anastomoses were stapled and 23 sutured; of the seven patients who died with local recurrent disease, six had stapled anastomoses (Fisher's exact probability F2=0.12; log rank chi-square=3.53, 0.05<P<0.10). Two patients who died with locally recurrent disease had had clinically apparent anastomotic leads and one other patient had had a radiologically demonstrated leak. This compares with a total of seven leaks (clinical or radiologic) in the remaining group of 46 patients with no recurrence (Fisher's exact probability F2=0.11). These results tend to support the hypothesis that anastomotic leaks may lead to locally recurrent disease, particularly after stapled anastomoses
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Brennan SS, Pickford IR, Evans M, Pollock AV. Staples or sutures for colonic anastomoses—a controlled clinical trial. Br J Surg 1982; 69:722–4.
Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP. Local recurrence following “curative” surgery for large bowel cancer. Br J Surg 1984; 71:12–20.
Umpleby HC, Fermor B, Symes MO, Williamson RC. Viability of exfoliated colorectal carcinoma cells. Br J Surg 1984; 71:659–63.
Durdey P, Quirke P, Dixon MF, Williams NS. Lateral spread of rectal cancer, the key to local recurrence. Br J Surg 1986; 73:1042.
Heald RJ; Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986; 1:1479–82.
Keighley MR, Moore J, Lee JR, Malins D, Thompson H. Peroperative frozen section and cytology to assess proximal invasion in gastro-oesophageal carcinoma. Br J Surg 1981; 68:73–4.
Phillips RK, Cook HT. Effect of steel wire sutures on the incidence of chemically induced rodent colonic tumors. Br J Surg 1986; 73: 671–4.
Panton ON, Smith JA, Bell GA, Forward AD, Murphy J, Doyle PW. The incidence of wound infection after stapled or sutured bowel anastomosis and stapled or sutured skin closure in humans and guinea pigs. Surgery 1985; 98:20–4.
Hurst PA, Prout WG, Kelly JM, Bannister JJ, Walker RT. Local recurrence after low anterior resection using the staple gun. Br J Surg 1982; 69:275–6.
Anderberg B, Enblad P, Sjodahl R, Wetterfors J. Recurrent rectal carcinoma after anterior resection and rectal stapling. Br J Surg 1984; 70:1–4.
Bokey EL, Chapuis PH, Hughes WJ, Koorey SG, Dunn D. Local recurrence following anterior resection for carcinoma of the rectum with a stapled anastomosis. Acta Chir Scand 1984; 150: 683–6.
Leff EI, Shaver JO, Hoexter B et al. Anastomotic recurrences after low anterior resection: stapledvs. hand-sewn. Dis Colon Rectum 1985; 28:164–7.
Rosen CB, Beart RW Jr, Ilstrup DM. Local recurrence of rectal carcinoma after hand-sewn and stapled anastomoses. Dis Colon Rectum 1985; 28:305–9.
Pheils MT, Chapuis PH, Thomson AA, Payne JE, Newland RC. A pattern of local recurrence following resection of colorectal cancer. Aust NZ J Surg 1979; 49:663–8.
Williams NS, Durdey P, Johnston D. The outcome following sphincter-saving resection and abdomino-pertineal resection for low rectal cancer. Br J Surg 1985; 72:595–8.
Reid JS, Robins RE, Atkinson KG. Pelvic recurrence after anterior resection and EEA stapling anastomosis for potentially curable carcinoma of the rectum. Am J Surg 1984; 147:629–32
Wolmark N, Gordon PH, Fisher B, et al. A comparison of stapled and handsewn anastomoses in patients undergoing resection for Dukes' B and C colorectal cancer: an analysis of disease-free survival and survival from the NSABP prospective clinical trials. Dis Colon Rectum 1986; 29:344–50.
Neville R, Fielding LP, Arrendola C. Local tumor recurrence after curative resection for rectal cancer: a ten-hospital review. Dis Colon Rectum 1987;30:12–7
Author information
Authors and Affiliations
Additional information
Supported by the Scarborough Research Fund.
About this article
Cite this article
Sauven, P., Playforth, M.J., Evans, M. et al. Early infective complications and late recurrent cancer in stapled colonic anastomoses. Dis Colon Rectum 32, 33–35 (1989). https://doi.org/10.1007/BF02554722
Issue Date:
DOI: https://doi.org/10.1007/BF02554722