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Increased Leak Rates Following Stapled Versus Handsewn Ileocolic Anastomosis in Patients with Right-Sided Colon Cancer

A Nationwide Cohort Study

Nordholm-Carstensen, Andreas, M.D., Ph.D.1; Schnack Rasmussen, Morten, M.D.2; Krarup, Peter-Martin, M.D.1,3

Diseases of the Colon & Rectum: May 2019 - Volume 62 - Issue 5 - p 542–548
doi: 10.1097/DCR.0000000000001289
Original Contribution: Colorectal Cancer
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BACKGROUND: Data on anastomotic leak rates after stapled versus handsewn ileocolic anastomosis are conflicting. In a Cochrane review, the combined estimate favored the stapled technique, but recent cohort studies demonstrated a 2-fold increase in anastomotic leak with the stapled approach.

OBJECTIVE: The purpose of this study was to investigate anastomotic leak rates following stapled versus handsewn ileocolic anastomosis.

DESIGN: This was a nationwide, retrospective cohort study.

SETTING: Data were obtained from the Danish Colorectal Cancer Group and National Patient Registry databases.

PATIENTS: Danish patients, ≥18 years of age, undergoing right hemicolectomy for a first-time diagnosis of adenocarcinoma in the right colon with primary anastomosis between October 2014 and December 2015 were included.

MAIN OUTCOME MEASURES: The primary outcome was anastomotic leak rate. Secondary outcomes included 30-day mortality. Covariates included demographics, comorbidity, tumor stage, and surgical variables. Multivariable logistic regression and propensity score matching were used to adjust for confounding.

RESULTS: The 1414 patients included 391 (28%) in the stapled group and 1023 (72%) in the handsewn group. Forty-five patients (3.2%) developed anastomotic leak: 21 of 391 (5.4%) and 24 of 1023 (2.4%) in the stapled and handsewn group (p = 0.004). This difference was confirmed in multivariable analysis (adjusted OR, 2.91; 95% CI, 1.53–5.53; p < 0.001), and after propensity score matching (OR, 2.41; 95% CI, 1.24–4.67; p = 0.009). Thirty-day mortality was 15.6% (7/45) and 2.1% (29/1369) in patients with and without anastomotic leak (p < 0.001), with no difference between the stapled and handsewn approach.

LIMITATIONS: The study’s design was retrospective, with no information on allocation to the stapled or handsewn approach.

CONCLUSIONS: The present study demonstrated a 2-fold increase in anastomotic leak after stapled versus handsewn ileocolic anastomoses. Previous opinions on the optimal anastomosis technique for colon cancer should be scrutinized given the devastating short-term outcome of anastomotic leak. See Video Abstract at

1 Department of Surgery, Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark

2 Digestive Disease Center, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark

3 Danish Colorectal Cancer Group, Copenhagen, Denmark

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Funding/Support: None reported.

Financial Disclosures: None reported.

Presented at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, WA, June 10 to 14, 2017.

Correspondence: Andreas Nordholm-Carstensen, M.D., Ph.D., Department of Surgery, Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons