Comparison of The Application of Double Stapling Technique and Single Stapling Technique in The Low or Ultralow Anterior Rectal Resection and Colon-Anal Canal Anastomosis for Patients with Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GUAN Xiuwen ^1,2 , LI Shanchen ^1,2 , WANG Xiaodong ^1,2 ,  LI Li ^1,2

1.Surgery Center of Gastroenterology， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;;
2.West China Medical School/MCQ Group of West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

LI Li, Email: drlili116@126.com

Keywords：

Stapling; Rectal cancer; Colon-anal canal anastomosis; Low anterior resection

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Objective 　To compare the effects of double stapling technique （DST） and single stapling technique （SST） in the low or ultralow anterior rectal resection and colon-anal canal anastomosis for patients with rectal cancer.
Methods 　The clinical data of 351 patients with rectal caner， who were treated with low or ultralow anterior resection and colon-anal canal anastomosis in West China Hospital from Jan. 2009 to Dec. 2010， were collected and analyzed retrospectively. Operative and postoperative indexes of patients treated with DST （n=302） and SST （n=49） were compared.
Results 　Compared with DST group， the distance from the dentate line to the edge of tumor， the length of the distal surgical margin 〔（1.83±0.59） cm vs. （2.07±0.56） cm〕， and hospitalization cost 〔（24 350.48±7 812.73） yuan vs.
（29 455.32±7 869.33） yuan〕 of SST group were shorter or lower （P＜0.05）， but operative time was longer 〔（112.86±
39.29） min vs. （100.10±36.75） min， P＜0.05〕. There were no significant differences on blood loss， duration of first
ambulation， duration of first passing flatus， duration of first bowel movement， duration of pulling out nasogastric tube， duration of pulling out urinary catheter， duration of pulling out drain， postoperative hospital stay， total length of hospital stay， and the incidence of complication between the 2 groups （P＞0.05）. All patients were in functional recovery of anal control after operation. All patients were followed-up for 6-24 months （average 16 months）. During the followed-up， only 1 case suffered local tumor recurrence （SST group）， 3 cases suffered distant metastases （all in DST group）， and 15 cases （4.27％） died， of which 13 cases （4.30％） in DST group and 2 cases （4.08％） in SST group.
Conclusions 　As in the low or ultralow anterior rectal resection and colon-anal canal anastomosis for patients with rectal cancer， SST results in shorter distal surgical margin than DST， so SST is suitable for the patients with shorter distance from the dentate line to the edge of tumor. What’s more， it saves the hospitalization cost effectively.

Citation： GUAN Xiuwen,LI Shanchen,WANG Xiaodong,LI Li,.. Comparison of The Application of Double Stapling Technique and Single Stapling Technique in The Low or Ultralow Anterior Rectal Resection and Colon-Anal Canal Anastomosis for Patients with Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(3): 287-292. doi: Copy

1.	邱辉忠. 双吻合技术在低位直肠肿瘤手术中的应用[J]. 中国实用外科杂志， 2005， 25(3)：15-17.
2.	Paty PB， Enker WE， Cohen AM， et al. Treatment of rectal cancerby low anterior resection with coloanal anastomosis[J]. Ann Surg， 1994， 219(4)：365-373.
3.	吕东昊，汪晓东，阳川华，等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状[J]. 中国普外基础与临床杂志， 2007， 14(6)：713-715.
4.	李立，汪晓东，舒晔，等. 四川大学华西医院·结直肠肠癌手术治疗指南 (一)[J]. 中国普外基础与临床杂志， 2008， 15(10)：778.
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11.	Rullier E， Laurent C， Bretagnol F， et al. Sphincter-saving resection for all rectal carcinomas：the end of the 2 cm distal rule[J]. Ann Surg， 2005， 241(3)：465-469.
12.	Schiessel R， Karner-Hanusch J， Herbst F， et al. Intersphincteric resection for low rectal tumours[J]. Br J Surg， 1994， 81(9)：1376-1378.
13.	Knight CD， Griffen FD. An improved technique for low anterior resection of the rectum using the EEA stapler[J]. Surgery， 1980， 88(5)：710-714.
14.	Shrikhande SV， Saoji RR， Barreto SG， et al. Outcomes of resection for rectal cancer in India：the impact of the double stapling technique[J]. World J Surg Oncol， 2007， 5：35.
15.	Akiyoshi T， Ueno M， Fukunaga Y， et al. Incidence of and risk factors for anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer[J]. Am J Surg， 2011， 202(3)：259-264.
16.	丁卫星. 腹腔镜直肠前切除术的双吻合技巧[J]. 中华胃肠外科杂志， 2012， 15(8)：790-792.
17.	Tsubaki M， Ito Y， Fujita M， et al. Use of the modified double-stapling technique with vertical division of the rectum during a sphincter-preserving operation for the treatment of a rectal tumor[J]. Asian J Surg， 2012， 35(3)：110-112.
18.	Yamamoto H， Sekimoto M， Uemura M， et al. Feasibility of end-to-anterior wall anastomosis in conversion of the double-stapling technique during laparoscopically assisted surgery[J]. SurgEndosc， 2010， 24(9)：2178-2181.
19.	Misawa T， Sakamoto T， Ito R， et al. Single-incision laparoscopicsplenectomy using the “tug-exposure technique” in adults：results of ten initial cases[J]. Surg Endosc， 2011， 25(10)：3222-3227.
20.	Okuda J， Tanaka K， Kondo K， et al. Safe anastomosis in laparoscopic low anterior resection for rectal cancer[J]. Asian J EndoscSurg， 2011， 4(2)：68-72.
21.	姚宏伟. 外翻拖出式单吻合器技术在低位直肠癌保肛术中的应用体会[J]. 中国肛肠病杂志， 2012， 32(10)：16-17.
22.	Moore JW， Chapuis PH， Bokey EL. Morbidity and mortality after single-and double-stapled colorectal anastomoses in patients with carcinoma of the rectum[J]. Aust N Z J Surg， 1996， 66(12)：820-823.
23.	Sato H， Maeda K， Hanai T， et al. Modified double-stapling technique in low anterior resection for lower rectal carcinoma[J]. Surg Today， 2006， 36(1)：30-36.
24.	Bozzetti F， Bertario L， Bombelli L， et al. Double versus single stapling technique in rectal anastomosis[J]. Int J Colorectal Dis， 1992， 7(1)：31-34.
25.	周活动. 单吻合器与双吻合器技术在直肠癌低位前切除术中的临床应用分析[J]. 结直肠肛门外科， 2010， 16(4)：214-216.
26.	魏正强，张才全，朱明才，等. 低位直肠癌应用经肛门拖出单吻合器技术保肛的临床研究[J]. 第三军医大学学报， 2010， 32(3)：282-284.
27.	陈斌武，黄明. 单吻合器行直肠癌超低位保肛术30例临床观察[J]. 中国肛肠病杂志， 2012， 32(2)：23-24.

1. 邱辉忠. 双吻合技术在低位直肠肿瘤手术中的应用[J]. 中国实用外科杂志， 2005， 25(3)：15-17.
2. Paty PB， Enker WE， Cohen AM， et al. Treatment of rectal cancerby low anterior resection with coloanal anastomosis[J]. Ann Surg， 1994， 219(4)：365-373.
3. 吕东昊，汪晓东，阳川华，等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状[J]. 中国普外基础与临床杂志， 2007， 14(6)：713-715.
4. 李立，汪晓东，舒晔，等. 四川大学华西医院·结直肠肠癌手术治疗指南 (一)[J]. 中国普外基础与临床杂志， 2008， 15(10)：778.
5. 李立，汪晓东，舒晔，等. 四川大学华西医院·结直肠肠癌手术治疗指南 (二)[J]. 中国普外基础与临床杂志， 2008， 15(11)：861-862.
6. 李立，汪晓东，舒晔，等. 四川大学华西医院·结直肠肠癌手术治疗指南 (三)[J]. 中国普外基础与临床杂志， 2008， 15(12)：941-942.
7. 顾晋. 低位直肠癌的外科手术[J]. 肿瘤学杂志， 2006， 12(1)：27-30.
8. Paty PB， Cohen AM. The role of surgery and chemoradiation therapy for cancer of the rectum[J]. Curr Probl Cancer， 1999， 23(5)：229-249.
9. Williams NS. The rationale for preservation of the anal sphincter in patients with low rectal cancer[J]. Br J Surg， 1984， 71(8)：575-581.
10. Pollett WG， Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum[J]. Ann Surg， 1983， 198(2)：159-163.
11. Rullier E， Laurent C， Bretagnol F， et al. Sphincter-saving resection for all rectal carcinomas：the end of the 2 cm distal rule[J]. Ann Surg， 2005， 241(3)：465-469.
12. Schiessel R， Karner-Hanusch J， Herbst F， et al. Intersphincteric resection for low rectal tumours[J]. Br J Surg， 1994， 81(9)：1376-1378.
13. Knight CD， Griffen FD. An improved technique for low anterior resection of the rectum using the EEA stapler[J]. Surgery， 1980， 88(5)：710-714.
14. Shrikhande SV， Saoji RR， Barreto SG， et al. Outcomes of resection for rectal cancer in India：the impact of the double stapling technique[J]. World J Surg Oncol， 2007， 5：35.
15. Akiyoshi T， Ueno M， Fukunaga Y， et al. Incidence of and risk factors for anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer[J]. Am J Surg， 2011， 202(3)：259-264.
16. 丁卫星. 腹腔镜直肠前切除术的双吻合技巧[J]. 中华胃肠外科杂志， 2012， 15(8)：790-792.
17. Tsubaki M， Ito Y， Fujita M， et al. Use of the modified double-stapling technique with vertical division of the rectum during a sphincter-preserving operation for the treatment of a rectal tumor[J]. Asian J Surg， 2012， 35(3)：110-112.
18. Yamamoto H， Sekimoto M， Uemura M， et al. Feasibility of end-to-anterior wall anastomosis in conversion of the double-stapling technique during laparoscopically assisted surgery[J]. SurgEndosc， 2010， 24(9)：2178-2181.
19. Misawa T， Sakamoto T， Ito R， et al. Single-incision laparoscopicsplenectomy using the “tug-exposure technique” in adults：results of ten initial cases[J]. Surg Endosc， 2011， 25(10)：3222-3227.
20. Okuda J， Tanaka K， Kondo K， et al. Safe anastomosis in laparoscopic low anterior resection for rectal cancer[J]. Asian J EndoscSurg， 2011， 4(2)：68-72.
21. 姚宏伟. 外翻拖出式单吻合器技术在低位直肠癌保肛术中的应用体会[J]. 中国肛肠病杂志， 2012， 32(10)：16-17.
22. Moore JW， Chapuis PH， Bokey EL. Morbidity and mortality after single-and double-stapled colorectal anastomoses in patients with carcinoma of the rectum[J]. Aust N Z J Surg， 1996， 66(12)：820-823.
23. Sato H， Maeda K， Hanai T， et al. Modified double-stapling technique in low anterior resection for lower rectal carcinoma[J]. Surg Today， 2006， 36(1)：30-36.
24. Bozzetti F， Bertario L， Bombelli L， et al. Double versus single stapling technique in rectal anastomosis[J]. Int J Colorectal Dis， 1992， 7(1)：31-34.
25. 周活动. 单吻合器与双吻合器技术在直肠癌低位前切除术中的临床应用分析[J]. 结直肠肛门外科， 2010， 16(4)：214-216.
26. 魏正强，张才全，朱明才，等. 低位直肠癌应用经肛门拖出单吻合器技术保肛的临床研究[J]. 第三军医大学学报， 2010， 32(3)：282-284.
27. 陈斌武，黄明. 单吻合器行直肠癌超低位保肛术30例临床观察[J]. 中国肛肠病杂志， 2012， 32(2)：23-24.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of The Application of Double Stapling Technique and Single Stapling Technique in The Low or Ultralow Anterior Rectal Resection and Colon-Anal Canal Anastomosis for Patients with Rectal Cancer

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